Background/Purpose: Primary total hip arthroplasty (THA) patients often have concomitant medical comorbidities. This study aims to identify the impact of diabetes mellitus (DM) on inpatient clinical and healthcare utilization outcomes in patients, and whether this association varies by the underlying primary diagnoses.

Methods: We identified patients over the age of 18 who underwent THA in the 2019 National Inpatient Sample (NIS). We stratified patients by primary diagnosis into hip osteoarthritis (OA; N=405691), avascular necrosis (AVN; N=17060), fracture (N=104265), inflammatory arthritis (IA; N=5720) (includes rheumatoid arthritis [RA], spondylarthritis [SpA], including ankylosing spondylitis, and psoriatic arthritis [PsA]), vs. other. We identified underlying diagnoses using primary diagnosis codes and diabetes and complications using secondary diagnosis codes. We performed multivariable-adjusted regression analyses for clinical and healthcare utilization outcomes as endpoints, adjusted for race, age, sex, hospital bed size, census region, and teaching status.

Results: Total cohort population was 591,891, with 101,385 classified as diabetic. Mean age was 68.75, mean length of stay (LOS) was 2.73 days, and 58.20% were female. Overall, DM was associated with increased LOS, non-routine discharge (i.e., to a facility), and acute renal failure (ARF) (p≤0.05 each). Patients in the OA or fracture cohorts with DM were more likely to have non-routine discharges (p≤0.001 each). DM was significantly associated with an increased risk of longer LOS and ARF in OA, fracture, and IA cohorts (p≤0.03 each). DM was associated with increased risk of blood transfusions (p=0.031), and a lower risk of pneumonia and prosthetic complications in the fracture cohort (p≤0.016 each).

Conclusion: DM was associated with increased healthcare utilization and ARF following primary THA, indicating associated healthcare resource and clinical burden. The variation in association of DM with outcomes post-primary THA for people with AVN or fractures, identifies differential effect in elective versus non-elective cases that needs further study.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diabetes-mellitus-impacts-primary-total-hip-arthroplasty-outcomes-a-national-cohort-study/