Introduction: With the increasing elderly population and obesity epidemic, diabetes is an important factor in arthroplasty planning. Although research suggests diabetes is associated with increased postoperative morbidity after hip and knee replacement, the effect of diabetes and varying management with insulin versus non-insulin agents on total shoulder arthroplasty (TSA) is not established.
Methods: All TSAs from 2015-2016 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Age, gender, BMI, and smoking status were compared between all diabetics, diabetics on insulin, diabetics on non-insulin agents, and non-diabetics to account for confounding variables. Thirty day postoperative complications, readmission rate, dislocations, SSI, and non-routine discharge to rehabilitation were compared using bivariate and multivariate binary logistic regression. Postoperative time to discharge between diabetic groups was analyzed using univariate ANOVA with Tukey’s test. Statistical analysis with p<0.05 was performed using SPSS Software.
Results: The analysis included 7246 patients (Insulin in 5% (n=380), Non-insulin in 13% (n=922), and Non diabetics in 82% (n=5944)). Bivariate logistic regression showed statistical significance in readmission, post-operative dislocation, and non-routine discharge between all diabetics and non-diabetics (OR 1.7, 2.1, 1.4 respectively; P=0.001, 0.026, 0.001) but there was no significance between SSI rate (0.3% vs 0.4%; P=0.924). Multivariate logistic regression between groups showed significance in readmission and dislocation in non-insulin diabetics vs non-diabetics (OR 1.5, 2.2; P=0.027, 0.041); readmission and non-routine discharge in insulin vs non-diabetics (OR 2.1, 1.7; P=0.003, <0.001); no significance between insulin and non-insulin diabetics. Postoperative days to discharge was 2.4, 1.9, and 1.7 days in insulin, non-insulin, and non- diabetics respectively. Mean differences were significant between all groups.
Conclusion: Diabetic patients are at a higher risk for readmission, dislocation, and non-routine discharge compared to non-diabetics. Despite no increased risk in SSI, longer postoperative discharge time in diabetics should be considered in TSA planning.
