title: Impact of diabetes on early postoperative outcomes after total elbow arthroplasty.
abstract: BACKGROUND
  Diabetes is known to be associated with poorer perioperative outcomes after hip, knee, and shoulder arthroplasty. This study is the first, to our knowledge, to examine the association between diabetes and in-hospital complications, length of stay, non-homebound discharge, transfusion risk, and total charges after total elbow arthroplasty (TEA).
  
  
  METHODS
  By use of International Classification of Diseases, Ninth Revision codes, epidemiologic as well as patient and hospital demographic data for all patients undergoing TEA were extracted from the Nationwide Inpatient Sample from 2007 through 2011. We found 13,698 patients who underwent TEA and subsequently separated them into 2 cohorts, those patients with (16.5%) and without (83.5%) diabetes. Specific outcome measures between the diabetic and nondiabetic cohorts were compared through bivariate and multivariate analyses.
  
  
  RESULTS
  Diabetic patients had significantly longer lengths of stay, increased rates of needing a transfusion perioperatively, and higher rates of a number of complications after TEA compared with the nondiabetic group. Significant differences in demographic factors in diabetic patients compared with nondiabetic patients included age, gender, insurance type, and geography. Diabetes was an independent predictor of both prolonged hospital stay and non-homebound discharge after TEA.
  
  
  CONCLUSIONS
  Diabetic patients have significantly higher rates of several perioperative complications, and diabetes is an independent risk factor for prolonged hospital stay, as well as increased risk of non-homebound discharge. Future studies need to further investigate this relationship between diabetes and poorer TEA outcomes.
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Pope
authors.affiliation: Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Scaife
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Tony H
authors.initials: TH
authors.lastname: Tzeng
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Vasdev
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA. Electronic address: ksaleh@siumed.edu.
authors.forename: Khaled J
authors.initials: KJ
authors.lastname: Saleh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow; D001803:Blood Transfusion; D016022:Case-Control Studies; D015331:Cohort Studies; D048909:Diabetes Complications; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012307:Risk Factors; D014481:United States
keywords: Nationwide Inpatient Sample; Total elbow arthroplasty; blood transfusion; complications; diabetes; discharge; length of stay