title: Comparison of perioperative complications after total elbow arthroplasty in patients with and without diabetes.
abstract: BACKGROUND
  Few studies have analyzed the effect of diabetes on outcomes after total elbow arthroplasty (TEA). We investigated the perioperative complications after TEA in patients with and without diabetes.
  
  
  METHODS
  We evaluated the Nationwide Inpatient Sample (NIS) database from 2005 to 2010 for patients who underwent a TEA. Our retrospective study included 3184 patients based on International Classification of Diseases-Ninth Revision, Clinical Modification codes. We compared outcomes in 488 patients with diabetes and in 2696 patients without diabetes.
  
  
  RESULTS
  Patients with diabetes had a significantly older mean age (66.8 vs 58.5 years, P < .001). There was no statistically significant difference when comparing length of stay (4.1 vs 3.7 days, P = .056) and cost of surgery ($56,582 vs $56,092, P = .833). A significantly higher percentage of diabetic patients underwent TEA for the indication of fracture (73.4% vs 65.3%), but a lower percentage for rheumatoid arthritis (10.2% vs 19.2%). They also had significantly increased rates of pneumonia (odds ratio [OR], 2.7), urinary tract infection (OR, 2.2), blood transfusion (OR, 2.1), and nonroutine discharge (OR, 1.9). After adjusting for significantly increased rates of comorbidities in diabetic patients, our multivariate analysis showed that having diabetes was independently associated with an increased risk of pneumonia (relative risk [RR], 2.6), urinary tract infection (RR, 1.9), and cerebrovascular accident (RR, 9.1). However, diabetes was not independently associated with hospital length of stay (P = .75), after correction, hospital cost (P = .63), or proportion of routine discharges (P = .12).
  
  
  CONCLUSIONS
  Patients with diabetes have higher rates of comorbidities and perioperative complications after TEA.
authors.affiliation: Department of Orthopaedic Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Aneet S
authors.initials: AS
authors.lastname: Toor
authors.affiliation: Department of Orthopaedic Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Jimmy J
authors.initials: JJ
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedic Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Shi
authors.affiliation: Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, IL, USA. Electronic address: kohj1@hotmail.com.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects* / Q000706:statistics & numerical data; D015897:Comorbidity; D016208:Databases, Factual; D048909:Diabetes Complications / Q000453:epidemiology; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000092464:Elbow Injuries
keywords: Total elbow arthroplasty; complication; diabetes; perioperative outcome