Abstract
Background:
Diabetes is a well-established risk factor for a multitude of adverse outcomes in total knee arthroplasty (TKA). However, the effects of prediabetes (hemoglobin A1c 5.7%-6.4%) on TKA patient outcomes have yet to be fully elucidated.Purpose:We sought to compare inpatient rates of postoperative complications and resource use in patients with and without prediabetes undergoing primary, elective TKA.
Methods:We performed a retrospective cohort study using data from the Nationwide Inpatient Sample to identify patients with and without prediabetes undergoing unilateral, primary, elective TKA from January 1, 2017 to December 31, 2020. Patients with prediabetes were matched 1:1 to patients without prediabetes. There were 65 330 patients identified and included, with half in each cohort.
Results:For patients undergoing TKA, having prediabetes was associated with higher rates of respiratory failure (0.4% vs 0.3%), aspiration pneumonitis (0.05% vs 0.02%), postoperative urinary retention (2.4% vs 2.0%), postoperative constipation (3.7% vs 2.8%), postoperative nausea and vomiting (3.3% vs 3.0%), postoperative anemia (15.0% vs 12.9%), hypotension (3.1% vs 2.2%), wound dehiscence (0.03% vs 0.00%), and infection (0.11% vs 0.05%) compared to patients without prediabetes. Having prediabetes was associated with increased total costs ($17 197 vs $15 544).
Conclusion:This retrospective cohort study found that in TKA patients, prediabetes was associated with higher rates of postoperative complications and increased costs compared to patients without prediabetes.
Level of Evidence:Level III: retrospective cohort study.