INTRODUCTION• Diabetes is a known risk factor for postoperative complications

following arthroscopy.

• Diabetes can further be stratified by their method of glycemic control:

• Insulin-dependence (IDDM), and • Non-insulin dependent diabetes (NIDDM)

• It has been shown that patients with IDDM have much higher risks for morbidity and mortality following lower extremity arthroplasty.

• The goal of this study is to compare complications following shoulder and knee arthroscopy in patients with IDDM and NIDDM.

• Our hypothesis is that patients with IDDM will have a higher risk for postoperative complications than nondiabetics and those with NIDDM after shoulder arthroscopy.

METHODS

• A retrospective analysis of the NSQIP database for the years 2005-2016.

• All patients undergoing shoulder or knee arthroscopy were identified by CPT code.

• All surgeries performed for infections were excluded.

• Logistic regressions were used to assess the relationship between diabetic treatment method and outcomes.

• Multivariate models adjusted for:• Demographics: age, gender, BMI• Comorbidities: hypertension, CHF, COPD,• Tobacco use• ASA classification• Functional status

Insulin Dependence Predicts Complications Following Shoulder and Knee Arthroscopy SA Traven, RA Reeves, ZJ Walton, SK Woolf, HS Slone

Medical University of South Carolina

Poster #246

RESULTS: Shoulder Arthroscopy• Patients with IDDM were at a much higher risk for:

• Medical complications by 55.2% (AOR 1.552, p=0.022), including• Pulmonary complications by 107% (2.078, p=0.027) • Urinary tract infections by 113% (2.129, p 0.042)

• Hospital readmission by 58.1% (AOR 1.581, p=0.004)

• 30-day mortality by 282% (AOR 3.821, p=0.019)

• Conversely, patients with NIDDM had comparable risks for medical and surgical complications, unplanned hospital admission, and mortality as nondiabetics following shoulder arthroscopy.

RESULTS: Knee Arthroscopy• Patients with IDDM were at a much higher risk for:

• Surgical complications by 119% (AOR 2.186, p=0.001), including • Deep infections by 208% (AOR 3.082, p<0.001)• Return to OR by 93% (AOR 1.933, p=0.002)

• Hospital readmission by 77.0% (AOR 1.770, p=0.002).

• However, NIDDM was not an independent risk factor for subsequent medical or surgical complications, unplanned hospital admission, or 30-day mortality following knee arthroscopy.

SA Traven, RA Reeves, ZJ Walton, SK Woolf, HS SloneMedical University of South Carolina

Insulin Dependence Predicts Complications Following Shoulder and Knee Arthroscopy

Poster #246

DISCLOSURE

REFERENCES

Our authors have some disclosures. More information can be found on the AAOS Orthopaedic Disclosure Program: http://www7.aaos.org/education/disclosure/search.aspx

Cancienne JM, Miller MD, Browne JA, Werner BC. Not All Patients With Diabetes Have the Same Risks: Perioperative Glycemic Control Is Associated With Postoperative Infection Following Knee Arthroscopy. Arthroscopy. February 2018. doi:10.1016/j.arthro.2017.11.034.

Clement RC, Haddix KP, Creighton RA, Spang JT, Tennant JN, Kamath GV. Risk Factors for Infection After Knee Arthroscopy: Analysis of 595,083 Cases From 3 United States Databases. Arthroscopy. 2016;32(12):2556-2561. doi:10.1016/j.arthro.2016.04.026.

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Lovecchio F, Beal M, Kwasny M, Manning D. Do patients with insulin-dependent and noninsulin-dependent diabetes have different risks for complications after arthroplasty? Clin Orthop Relat Res. 2014;472(11):3570-3575. doi:10.1007/s11999-014-3891-4.

Webb ML, Golinvaux NS, Ibe IK, Bovonratwet P, Ellman MS, Grauer JN. Comparison of Perioperative Adverse Event Rates After Total Knee Arthroplasty in Patients With Diabetes: Insulin Dependence Makes a Difference. The Journal of Arthroplasty. 2017;32(10):2947-2951. doi:10.1016/j.arth.2017.04.032.

Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P. The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. Bone Joint J. 2014;96-B(12):1637-1643. doi:10.1302/0301-620X.96B12.34378.

• Following shoulder arthroscopy, patients with IDDM were much more likely to have medical complications, 30-day hospital admission, and mortality.

• Following knee arthroscopy, patients with IDDM were much more likely to have surgical complications, including deep infection and return to OR, as well as hospital readmission.

• All of these risks diminished among those with NIDDM, with their adjusted risk profiles becoming comparable to those without diabetes.

• Physicians and hospitals should keep these issues in mind when risk-stratifying patients regarding prior to shoulder and knee arthroscopy.

CONCLUSIONS

SA Traven, RA Reeves, ZJ Walton, SK Woolf, HS SloneMedical University of South Carolina

Insulin Dependence Predicts Complications Following Shoulder and Knee Arthroscopy

Poster #246