Prediabetes as an Unrecognized Risk Factor for Inpatient Postoperative Complications after Total Knee Arthroplasty: A
David S Constantinescu1, Joseph P Costello2, Aneesh V Samineni3
1OrthoCarolina Hip and Knee Center, Charlotte, NC, USA.
Summary
Prediabetes increases the risk of complications and costs for patients undergoing total knee arthroplasty (TKA). This study found higher rates of adverse events and increased healthcare spending in TKA patients with prediabetes.
Area of Science:
- Orthopedic Surgery
- Endocrinology
- Health Services Research
Background:
- Diabetes is a known risk factor for adverse outcomes in total knee arthroplasty (TKA).
- The impact of prediabetes (hemoglobin A1c 5.7%-6.4%) on TKA outcomes remains unclear.
Purpose of the Study:
- To compare inpatient postoperative complication rates and resource utilization in TKA patients with and without prediabetes.
- To evaluate the association between prediabetes and outcomes following primary, elective TKA.
Main Methods:
- Retrospective cohort study utilizing the Nationwide Inpatient Sample (NIS) database.
- Inclusion of 65,330 patients undergoing unilateral, primary, elective TKA between January 1, 2017, and December 31, 2020.
- 1:1 matching of patients with prediabetes to those without prediabetes.
Main Results:
- Prediabetes was associated with significantly higher rates of postoperative complications, including respiratory failure, aspiration pneumonitis, urinary retention, constipation, nausea/vomiting, anemia, and hypotension.
- Specific complications like wound dehiscence and infection were also more frequent in the prediabetes cohort.
- Patients with prediabetes incurred higher total healthcare costs ($17,197 vs. $15,544).
Conclusions:
- Prediabetes is linked to an increased incidence of postoperative complications in TKA patients.
- The findings highlight the association between prediabetes and elevated healthcare costs following total knee arthroplasty.
- These results underscore the importance of considering prediabetes status in TKA patient management.
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