Diabetes Status Affects Odds of Body Mass Index-dependent Adverse Outcomes After Total Hip Arthroplasty

Impact of Demographic Variables on Recovery After Total Hip Arthroplasty

BACKGROUND

Several patient factors affect recovery after total hip arthroplasty (THA). However, the impact of these variables on patient-reported outcome measure recovery curves following THA has not been defined. Our goal was to quantify the influence of multiple variables on recovery after primary THA.

METHODS

There were 1,724 patients in a multicenter study included. Variables included sex, race/ethnicity, anxiety/depression, body mass index, tobacco, and preoperative opioid use. The Hip disability and Osteoarthritis Score for Joint Replacement (HOOS JR) was recorded at multiple time points. Recovery curves were created using longitudinal estimating equations.

RESULTS

Patients who were women, obese, or smokers demonstrated lower HOOS JR scores at all time points. Preoperative opioid use was also correlated with lower HOOS JR scores, but this difference diminished after 6 months. Black patients demonstrated lower HOOS JR scores compared to Caucasians, and this relative difference increased out to 1-year postoperatively (P = .018). Hispanics also had lower HOOS JR scores, but scores recovered at similar rates compared to non-Hispanics. Patients who had only anxiety or depression had similar HOOS JR scores compared to patients who did not have anxiety or depression. However, patients who had both anxiety and depression had lower HOOS JR scores compared to patients who had neither (P = .049), and this relative difference became greater at 1-year postoperatively (P = .002).

CONCLUSIONS

Several factors including race/ethnicity, opioid use, and mental health influence recovery trajectory following THA. This information helps provide more individualized counseling about expectations after THA and focus targeted interventions to improve outcomes in at-risk groups.

Adverse Events After Total Hip Arthroplasty are not Sufficiently Characterized by 30-Day Follow-Up: A Database Study

BACKGROUND

Many previous studies of total hip arthroplasty (THA) have focused on adverse events occurring within 30 days of surgery. Studies examining 90-day postoperative adverse events have typically not focused on the timing of adverse events within that period. The current study evaluated the rate and timing of adverse events within 90 days of THA.

METHODS

Adult THA patients between 2010 and 2020 Q3 were identified from a large administrative dataset. Rates and timing of 90-day adverse events were determined. The median, interquartile range, and middle 80% were calculated based on the time of diagnosis for each adverse event. These were also dichotomized as occurring before or after 30 days and predictive factors for later adverse events were determined.

RESULTS

Overall, 81,158 adverse events were noted, of which 56,500 (69.0%) were diagnosed within 30 days of surgery and 25,355 (31.0%) were diagnosed 31-90 days after surgery. The proportion of adverse events occurring 31-90 days after surgery ranged from 6% (transfusion) to 45% (wound dehiscence). Patients experiencing a later adverse event were more likely to be women and to have higher Elixhauser Comorbidity Index (ECI) scores.

CONCLUSION

Almost one-third of adverse events following THA were diagnosed between postoperative days 31 and 90, highlighting the importance of looking beyond 30 days when estimating patients' risk of postoperative adverse events. These data may inform future research, patient counseling, and prevention strategies.

Postoperative short-term mortality between insulin-treated and non-insulin-treated patients with diabetes after non-cardiac surgery: a systematic review and meta-analysis

Background

Diabetes mellitus is an independent risk factor for postoperative complications. It has been reported that insulin-treated diabetes is associated with increased postoperative mortality compared to non-insulin-treated diabetes after cardiac surgery; however, it is unclear whether this finding is applicable to non-cardiac surgery.

Objective

We aimed to assess the effects of insulin-treated and non-insulin-treated diabetes on short-term mortality after non-cardiac surgery.

Methods

Our study was a systematic review and meta-analysis of observational studies. PubMed, CENTRAL, EMBASE, and ISI Web of Science databases were searched from inception to February 22, 2021. Cohort or case-control studies that provided information on postoperative short-term mortality in insulin-treated diabetic and non-insulin-treated diabetic patients were included. We pooled the data with a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to rate the quality of evidence.

Results

Twenty-two cohort studies involving 208,214 participants were included. Our study suggested that insulin-treated diabetic patients was associated with a higher risk of 30-day mortality than non-insulin-treated diabetic patients [19 studies with 197,704 patients, risk ratio (RR) 1.305; 95% confidence interval (CI), 1.127 to 1.511; p < 0.001]. The studies were rated as very low quality. The new pooled result only slightly changed after seven simulated missing studies were added using the trim-and-fill method (RR, 1.260; 95% CI, 1.076-1.476; p = 0.004). Our results also showed no significant difference between insulin-treated diabetes and non-insulin-treated diabetes regarding in-hospital mortality (two studies with 9,032 patients, RR, 0.970; 95% CI, 0.584-1.611; p = 0.905).

Conclusion

Very-low-quality evidence suggests that insulin-treated diabetes was associated with increased 30-day mortality after non-cardiac surgery. However, this finding is non-definitive because of the influence of confounding factors.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021246752, identifier: CRD42021246752.

Insulin dependence increases the risk of postoperative complications and inferior outcome but not the survivorship of total joint arthroplasty among diabetic population: a systematic review and meta-analysis

PURPOSE

Diabetes mellitus (DM) has been associated with poorer outcomes in total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, it is not clear if insulin-dependent diabetes mellitus (IDDM) patients display more perioperative complications and a worse clinical outcome compared to patients with non-insulin-dependent diabetes mellitus (NIDDM).

METHODS

Medline, Scopus, and the Cochrane library were systematically searched from inception to December 2020 to identify studies evaluating the results of THA and TKA in IDDM and NIDDM patients. The primary outcomes of the review were the surgical and systemic complications, 30-day mortality and readmission, and revision arthroplasty. Secondary outcomes were the survival of the prosthetic joints and the Knee Society Score (KSS).

RESULTS

Thirteen studies with 54,215 patients were included in the review. IDDM patients showed a greater risk for developing periprosthetic joint infection (p = 0.02), wound complications (p = 0.01), 30-day readmission (p < 0.01) and mortality (p < 0.01), reoperation (p < 0.01), revision joint surgery (p = 0.02), and systemic complications (p < 0.01) than NIDDM patients. The KSS-knee score was similar in IDDM and NIDDM patients, but the KSS-function score was lower in IDDM patients (p = 0.002). The overall survival rates of the prosthetic joints were similar between the groups.

CONCLUSION

Among diabetic population who undergo THA and TKA, insulin dependence is a risk factor for postoperative complications, and inferior functional outcome but not for shorter survivorship of the prosthetic joints.