Diabetes and total knee arthroplasty: A nationwide analysis of complications, hospitalization outcomes and revision burden

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-05-12 DOI:10.1002/ksa.12696

Yaara Berkovich, Ela Cohen Nissan, David Maman, Michael Tobias Hirschmann, Yaniv Yonai, Yaniv Steinfeld, Yaron Berkovich

{"title":"Diabetes and total knee arthroplasty: A nationwide analysis of complications, hospitalization outcomes and revision burden","authors":"Yaara Berkovich, Ela Cohen Nissan, David Maman, Michael Tobias Hirschmann, Yaniv Yonai, Yaniv Steinfeld, Yaron Berkovich","doi":"10.1002/ksa.12696","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Total knee arthroplasty (TKA) is a frequently performed surgical procedure aimed at reducing pain, improving mobility, and restoring function in patients with advanced knee osteoarthritis. As patients undergoing TKA age, the prevalence of comorbidities, particularly diabetes, continues to rise. This study assesses post-operative complications, healthcare costs and hospital length of stay (LOS) among diabetic patients undergoing primary and revision TKA using nationwide data from the NIS database, employing propensity score matching (PSM) to minimize confounding variables. We hypothesized that diabetic patients undergoing TKA would experience higher complication rates, greater healthcare costs and longer hospital stays compared to non-diabetic controls.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective cohort analysis utilized data from the Nationwide Inpatient Sample from 2016 to 2019, including a total of 2,602,484 TKA patients: 561,340 with type 2 diabetes and 2,041,144 without diabetes. PSM was applied to create balanced cohorts, adjusting for baseline demographic and clinical differences. Outcomes analyzed included LOS, total hospitalization charges, post-operative complications and revision surgery rates. Statistical significance was set at <i>p</i> < 0.05.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Following PSM, diabetic patients exhibited significantly higher risks for post-operative complications, including sepsis, heart failure and surgical site infections, compared to matched non-diabetic controls. Diabetic patients also incurred significantly greater hospital charges ($64,694 vs. $59,952, <i>p</i> < 0.001). In revision TKA cases, diabetic patients demonstrated slightly longer LOS (3.5 days vs. 3.0 days, <i>p</i> < 0.001) and higher total hospital charges ($101,457 vs. $96,614, <i>p</i> = 0.015).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Diabetic patients undergoing TKA experience significantly higher complication rates, hospital charges and revision surgery burden. Orthopaedic surgeons and perioperative teams should implement personalized perioperative management strategies, including optimized glycaemic control, cardiovascular risk assessment and infection prevention measures, to mitigate these risks and improve clinical outcomes.</p>\n </section>\n \n <section>\n \n <h3> Levels of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3250-3260"},"PeriodicalIF":5.0000,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12696","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12696","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Total knee arthroplasty (TKA) is a frequently performed surgical procedure aimed at reducing pain, improving mobility, and restoring function in patients with advanced knee osteoarthritis. As patients undergoing TKA age, the prevalence of comorbidities, particularly diabetes, continues to rise. This study assesses post-operative complications, healthcare costs and hospital length of stay (LOS) among diabetic patients undergoing primary and revision TKA using nationwide data from the NIS database, employing propensity score matching (PSM) to minimize confounding variables. We hypothesized that diabetic patients undergoing TKA would experience higher complication rates, greater healthcare costs and longer hospital stays compared to non-diabetic controls.

Methods

This retrospective cohort analysis utilized data from the Nationwide Inpatient Sample from 2016 to 2019, including a total of 2,602,484 TKA patients: 561,340 with type 2 diabetes and 2,041,144 without diabetes. PSM was applied to create balanced cohorts, adjusting for baseline demographic and clinical differences. Outcomes analyzed included LOS, total hospitalization charges, post-operative complications and revision surgery rates. Statistical significance was set at p < 0.05.

Results

Following PSM, diabetic patients exhibited significantly higher risks for post-operative complications, including sepsis, heart failure and surgical site infections, compared to matched non-diabetic controls. Diabetic patients also incurred significantly greater hospital charges ($64,694 vs. $59,952, p < 0.001). In revision TKA cases, diabetic patients demonstrated slightly longer LOS (3.5 days vs. 3.0 days, p < 0.001) and higher total hospital charges ($101,457 vs. $96,614, p = 0.015).

Conclusions

Diabetic patients undergoing TKA experience significantly higher complication rates, hospital charges and revision surgery burden. Orthopaedic surgeons and perioperative teams should implement personalized perioperative management strategies, including optimized glycaemic control, cardiovascular risk assessment and infection prevention measures, to mitigate these risks and improve clinical outcomes.

Levels of Evidence

Level III.

Abstract Image

查看原文本刊更多论文

糖尿病和全膝关节置换术：一项全国性的并发症、住院结果和翻修负担分析。

目的：全膝关节置换术（TKA）是一种常用的外科手术，旨在减轻晚期膝关节骨关节炎患者的疼痛，改善活动能力和恢复功能。随着TKA患者年龄的增长，合并症的患病率，特别是糖尿病，继续上升。本研究使用来自NIS数据库的全国数据，采用倾向评分匹配（PSM）来最小化混杂变量，评估接受原发性和改进性TKA的糖尿病患者的术后并发症、医疗费用和住院时间（LOS）。我们假设与非糖尿病对照组相比，接受TKA的糖尿病患者会经历更高的并发症发生率、更高的医疗费用和更长的住院时间。方法：本回顾性队列分析利用2016 - 2019年全国住院患者样本数据，共纳入2602484例TKA患者，其中561340例为2型糖尿病患者，2041144例为非糖尿病患者。应用PSM创建平衡队列，调整基线人口统计学和临床差异。结果分析包括LOS、总住院费用、术后并发症和翻修手术率。结果：与匹配的非糖尿病对照组相比，PSM后糖尿病患者出现脓毒症、心力衰竭和手术部位感染等术后并发症的风险明显更高。糖尿病患者的住院费用也显著高于TKA患者（64,694美元对59,952美元）。结论：接受TKA的糖尿病患者并发症发生率、住院费用和翻修手术负担显著高于TKA患者。骨科医生和围手术期团队应实施个性化的围手术期管理策略，包括优化血糖控制、心血管风险评估和感染预防措施，以减轻这些风险，改善临床结果。证据等级：III级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).