Adverse in-hospital outcomes after shoulder arthroplasty by diabetes status: a retrospective study using the national inpatient sample

Abstract

Background Shoulder arthroplasty is a well-established surgical intervention for osteoarthritis, rotator cuff arthropathy, and complex shoulder diseases. While effective in pain relief and functional improvement, perioperative complications remain a major concern. Patients with diabetes present metabolic disturbances and suboptimal glycemic control, conferring higher risks of adverse perioperative events. Nevertheless, evidence regarding the impact of diabetes subtypes on short-term perioperative outcomes after shoulder arthroplasty remains scarce. This study employed the U.S. National Inpatient Sample (NIS) database to explore the association between diabetes subtypes and perioperative outcomes following shoulder arthroplasty. Method Data were derived from the National Inpatient Sample (NIS) database from 2016 to 2022. Patients undergoing shoulder arthroplasty were included and classified into three groups: patients with type 1 diabetes mellitus (T1DM), patients with type 2 diabetes mellitus (T2DM), and patients without diabetes. Patient demographics, hospital characteristics, surgical parameters, comorbidities, perioperative complications, and postoperative outcomes were assessed. Propensity score matching was applied to balance baseline characteristics between groups. Regression analyses were conducted to evaluate postoperative outcomes among patients with different DM subtypes. Result A total of 137,651 shoulder arthroplasty cases were identified, comprising 107,388 patients without diabetes, 376 patients with type 1 DM, and 29,887 patients with type 2 DM. Following propensity score matching, multivariate analysis demonstrated no significant between-group differences in most medical and surgical complications when comparing patients without diabetes and patients with type 1 DM. In contrast, type 2 DM was identified as an independent risk factor for pneumonia/acute respiratory failure (OR = 1.19, P < 0.001), surgical site/periprosthetic joint infection (OR = 1.25), urinary tract infection (OR = 1.25), acute renal failure (OR = 1.53), non-routine discharge (OR = 1.34), prolonged length of stay (GMR = 1.04), and increased total hospital charges (GMR = 1.02). Conclusion Compared with patients without diabetes, patients with type 2 DM undergoing shoulder arthroplasty exhibited higher risks of several adverse in-hospital outcomes, whereas most outcomes in patients with type 1 DM were not significantly different. These findings may facilitate improved risk stratification and tailored perioperative management.