- Prevalence of diabetic nephropathy among TKA patients rose from 1.2% in 2016 to 3.4% in 2019.
- DN associated with higher odds of pulmonary oedema (aOR 3.40), transfusion (aOR 1.64), myocardial infarction (aOR 2.13), periprosthetic infection and delirium.
- DN linked to increased length of stay and hospitalisation costs, supporting need for targeted perioperative risk mitigation.
J Orthop Surg (Hong Kong). 2026 Sep-Dec;34(3):10225536261488192. doi: 10.1177/10225536261488192. Epub 2026 Sep 8.
ABSTRACT
PurposeWhile diabetic nephropathy (DN) is a known risk factor for poor outcomes in major surgery, its specific impact on perioperative complications following primary total knee arthroplasty (TKA) has not been well-quantified in large-scale studies. This study aimed to determine the correlation of pre-existing DN on perioperative complications, mortality, and healthcare resource utilization in patients undergoing primary TKA.MethodsA retrospective cohort study utilized the US National Inpatient Sample (2016-2019). Patients undergoing primary TKA were stratified into DN and non-DN cohorts using ICD-10 codes, excluding end-stage renal disease or revision cases. A 1:1 propensity score-matched analysis was performed to balance demographics, hospital characteristics, and 30 comorbidities between cohorts. Outcomes included surgical/medical complications, mortality, length of stay (LOS), and hospitalization costs. Multivariable logistic regression analyzed associations pre- and post-PSM.ResultsDN prevalence increased significantly from 1.2% (2016) to 3.4% (2019). After PSM, DN patients had significantly higher adjusted risks of multiple complications. Surgical complications included increased transfusion (aOR=1.64), intubation/mechanical ventilation (aOR=1.52), periprosthetic infection (aOR=1.38). Medical complications included pulmonary edema (aOR=3.40), acute myocardial infarction (aOR=2.13), stroke (aOR=1.43), atrial fibrillation/flutter (aOR=1.09), postoperative delirium (aOR=1.66), urinary retention (aOR=1.26), and urinary tract infection (aOR=1.25). Resource utilization significantly increased, with higher odds of extended LOS (aOR=1.44) and elevated hospitalization costs (aOR=1.19).ConclusionThese findings underscore that DN is significantly associated with a distinct pattern of TKA complications, advocating for targeted perioperative strategies to mitigate risks in this growing population.
PMID:42710867 | DOI:10.1177/10225536261488192
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
