Effect of Insulin Dependence on Perioperative Risk in Patients With Diabetes Undergoing Total Shoulder Arthroplasty

Abstract

Background: Approximately 15% of patients who undergo total shoulder arthroplasty (TSA) have diabetes mellitus, and this group is particularly at risk for perioperative complications. The objective of this study was to quantify the effects of insulin dependence on the risk of 30-day perioperative adverse events after TSA in patients with diabetes mellitus using a large national database. Materials and Methods: We retrospectively identified patients with diabetes mellitus who underwent TSA in the National Surgical Quality Improvement Program (NSQIP) database from 2011 to 2020. Patients were grouped as having insulin-dependent or non–insulin-dependent diabetes mellitus. The primary outcome was 30-day complication, and secondary outcome variables included 30-day readmission, reoperation, and death. Multivariable logistic regression analyses adjusted for baseline differences were performed. The cohort included 5888 patients with diabetes mellitus who underwent TSA, with 1705 patients in the insulin-dependent group and 4183 patients in the non–insulin-dependent group. Results: The 30-day postoperative complication rate was higher in patients with insulin-dependent diabetes mellitus (8.7%) than in patients with non–insulin-dependent diabetes mellitus (5.6%). The 30-day hospital readmission rate was higher in patients with insulin-dependent diabetes mellitus (4.8%) than in patients with non–insulin-dependent diabetes mellitus (3.3%). These significant differences in complication and readmission rates persisted in the multivariable logistic regression analyses after adjusting for baseline differences between the two groups. Reoperation and death were not associated with insulin dependence. Conclusion: Patients with insulin-dependent diabetes mellitus have higher odds of episode-of-care complication and readmission compared with patients with non–insulin-dependent diabetes mellitus, even after adjusting for between-group baseline differences. [ Orthopedics . 20XX;4X(X):XXX–XXX.]