Diabetes mellitus as a risk factor for postoperative complications following arthroscopic rotator cuff repair

Patricia E Cerri-Droz; Kenny Ling; Samuel Aknoukh; David E Komatsu; Edward D Wang

doi:10.1016/j.jseint.2023.06.024

Diabetes mellitus as a risk factor for postoperative complications following arthroscopic rotator cuff repair

JSES Int. 2023 Jul 24;7(6):2361-2366. doi: 10.1016/j.jseint.2023.06.024. eCollection 2023 Nov.

Authors

Patricia E Cerri-Droz¹, Kenny Ling², Samuel Aknoukh², David E Komatsu², Edward D Wang²

Affiliations

¹ Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
² Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA.

Abstract

Background: Patients with diabetes mellitus who undergo arthroscopic rotator cuff repair (aRCR) have an increased risk of postoperative complications when compared to nondiabetics. To further investigate these complications, we used a large national database to determine the 30-day postoperative complications associated with insulin-dependent and non-insulin-dependent diabetics following aRCR.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all patients who underwent aRCR between 2015 and 2020. The study population was categorized into cohorts based on diabetes mellitus status: non-insulin-dependent diabetes mellitus (NIDDM), insulin-dependent diabetes mellitus (IDDM), and no diabetes. Multivariate analysis, adjusted for confounding demographics and comorbidities, was used to determine independently associated complications.

Results: There were 39,877 cases of aRCR in NQSIP included in this study. Diabetics comprised 6575 (16.7%) of these cases, with 4758 being NIDDM (11.9%) and 1817 being IDDM (4.6%). Bivariate logistic regression found both NIDDM and IDDM cohorts to be significantly associated with higher body mass index, ASA class ≥3, hypertension, chronic obstructive pulmonary disease, bleeding disorders, and preoperative wounds or infection (P < .001). NIDDM was an independently associated risk factor for sepsis (odds ratio [OR], 2.77; 95% confidence interval [CI]: 1.01-7.58; P = .047). IDDM was an independently associated risk factor for pneumonia (OR, 2.49; 95% CI: 1.13-5.48; P = .023), readmission (OR, 1.617; 95% CI: 1.19-2.33; P = .003), myocardial infarction (OR, 0.50; 95% CI: 0.12-1.00; P = .048), and on a ventilator >48 hours (OR, 5.63; 95% CI: 1.40-22.62; P = .015).

Conclusion: NIDDM is an independent risk factor for sepsis, while IDDM is an independent risk factor for pneumonia, readmission, myocardial infarction, and remaining on a ventilator for greater than 48 hours following aRCR.

Keywords: Arthroscopic rotator cuff repair; Complications; Diabetes; Insulin; Rotator cuff repair; Shoulder arthroscopy.