Risks Greater for Type 1 Than for Type 2 Diabetes

SAN FRANCISCO — Patients with type 1 diabetes were more likely than those with type 2 diabetes to die or develop perioperative complications after undergoing total knee or hip arthroplasty, a review of 65,769 cases found.

A bivariate analysis that directly compared complications in the two diabetes groups without adjusting for confounders showed that 0.7% with type 1 diabetes and 0.3% with type 2 diabetes died in association with the total joint replacement surgery, Dr. Michael P. Bolognesi and his associates reported in a poster presentation at the annual meeting of the American Academy of Orthopaedic Surgeons.

The risk of death related to total joint arthroplasty in type 2 diabetes patients was 56% lower than that in type 1 diabetes patients.

The investigators used federal data from the 2003 National Inpatient Sample to compare the rates of complications between 8,728 patients who had type 1 diabetes and 57,041 patients who had type 2 diabetes and underwent primary and revision arthroplasties of the hip or knee from 1998 to 2003.

Their analysis was based on regression modeling to control for the potential confounding effects of age, race, gender, and median household income by zip code.

Type 2 diabetes patients were about 30% less likely than type 1 diabetes patients to develop a urinary tract infection, pneumonia, or postoperative hemorrhage; they were about 50% less likely to develop an infection related to the surgery, said Dr. Bolognesi of Duke University, Durham, N.C.

Each of the differences they found between groups was statistically significant.

Perioperative urinary infections occurred in 5% of patients with type 1 diabetes and in 3% with type 2 diabetes. Pneumonia developed in 0.8% of the type 1 diabetes group and in 0.5% of the type 2 diabetes group.

Postoperative hemorrhage after total knee or hip arthroplasty was seen in 2% of the type 1 diabetes group and in 1% of the type 2 diabetes group. Infection occurred in 0.8% of patients with type 1 diabetes and in 0.4% with type 2 diabetes.

The mean length of stay in the hospital after total joint arthroplasty was 6 days in the type 1 diabetes group at a mean inflation-adjusted cost of $33,000, and 5 days in the type 2 diabetes group at a mean inflation-adjusted cost of $31,000.

Each of these differences between groups in the bivariate analysis was statistically significant.

There were no significant differences between groups in the rates of cerebrovascular accident, mental status changes, ileus, deep vein thrombosis, pulmonary embolism, thrombophlebitis, transfusion, other wound complications, or routine discharge.

“Total joint replacement is a highly effective treatment for degenerative hip and knee conditions, despite the presence of patient comorbidities,” Dr. Bolognesi said.

Diabetes increases the risk of perioperative complications, and the different underlying pathologies of the two types of diabetes may affect the perioperative risks, he added. “As diabetes and the need for hip and knee replacements both become more prevalent, an increasingly multidisciplinary approach to the care of these patients may be one answer for improving their clinical outcomes and health care resource utilization.”

Dr. Bolognesi reported that he is a consultant to four companies that market orthopedic products, instruments, or implants: ORTHOsoft Inc., DePuy Orthopaedics Inc., Zimmer Inc., and AMEDICA Corp. He owns stock or has stock options in two of those companies, and has received research funding and nonincome support, such as equipment, from three of them.

SAN FRANCISCO — Patients with type 1 diabetes were more likely than those with type 2 diabetes to die or develop perioperative complications after undergoing total knee or hip arthroplasty, a review of 65,769 cases found.

A bivariate analysis that directly compared complications in the two diabetes groups without adjusting for confounders showed that 0.7% with type 1 diabetes and 0.3% with type 2 diabetes died in association with the total joint replacement surgery, Dr. Michael P. Bolognesi and his associates reported in a poster presentation at the annual meeting of the American Academy of Orthopaedic Surgeons.

The risk of death related to total joint arthroplasty in type 2 diabetes patients was 56% lower than that in type 1 diabetes patients.

The investigators used federal data from the 2003 National Inpatient Sample to compare the rates of complications between 8,728 patients who had type 1 diabetes and 57,041 patients who had type 2 diabetes and underwent primary and revision arthroplasties of the hip or knee from 1998 to 2003.

Their analysis was based on regression modeling to control for the potential confounding effects of age, race, gender, and median household income by zip code.

Type 2 diabetes patients were about 30% less likely than type 1 diabetes patients to develop a urinary tract infection, pneumonia, or postoperative hemorrhage; they were about 50% less likely to develop an infection related to the surgery, said Dr. Bolognesi of Duke University, Durham, N.C.

Each of the differences they found between groups was statistically significant.

Perioperative urinary infections occurred in 5% of patients with type 1 diabetes and in 3% with type 2 diabetes. Pneumonia developed in 0.8% of the type 1 diabetes group and in 0.5% of the type 2 diabetes group.

Postoperative hemorrhage after total knee or hip arthroplasty was seen in 2% of the type 1 diabetes group and in 1% of the type 2 diabetes group. Infection occurred in 0.8% of patients with type 1 diabetes and in 0.4% with type 2 diabetes.

The mean length of stay in the hospital after total joint arthroplasty was 6 days in the type 1 diabetes group at a mean inflation-adjusted cost of $33,000, and 5 days in the type 2 diabetes group at a mean inflation-adjusted cost of $31,000.

Each of these differences between groups in the bivariate analysis was statistically significant.

There were no significant differences between groups in the rates of cerebrovascular accident, mental status changes, ileus, deep vein thrombosis, pulmonary embolism, thrombophlebitis, transfusion, other wound complications, or routine discharge.

“Total joint replacement is a highly effective treatment for degenerative hip and knee conditions, despite the presence of patient comorbidities,” Dr. Bolognesi said.

Diabetes increases the risk of perioperative complications, and the different underlying pathologies of the two types of diabetes may affect the perioperative risks, he added. “As diabetes and the need for hip and knee replacements both become more prevalent, an increasingly multidisciplinary approach to the care of these patients may be one answer for improving their clinical outcomes and health care resource utilization.”

Dr. Bolognesi reported that he is a consultant to four companies that market orthopedic products, instruments, or implants: ORTHOsoft Inc., DePuy Orthopaedics Inc., Zimmer Inc., and AMEDICA Corp. He owns stock or has stock options in two of those companies, and has received research funding and nonincome support, such as equipment, from three of them.

SAN FRANCISCO — Patients with type 1 diabetes were more likely than those with type 2 diabetes to die or develop perioperative complications after undergoing total knee or hip arthroplasty, a review of 65,769 cases found.

A bivariate analysis that directly compared complications in the two diabetes groups without adjusting for confounders showed that 0.7% with type 1 diabetes and 0.3% with type 2 diabetes died in association with the total joint replacement surgery, Dr. Michael P. Bolognesi and his associates reported in a poster presentation at the annual meeting of the American Academy of Orthopaedic Surgeons.

The risk of death related to total joint arthroplasty in type 2 diabetes patients was 56% lower than that in type 1 diabetes patients.

The investigators used federal data from the 2003 National Inpatient Sample to compare the rates of complications between 8,728 patients who had type 1 diabetes and 57,041 patients who had type 2 diabetes and underwent primary and revision arthroplasties of the hip or knee from 1998 to 2003.

Their analysis was based on regression modeling to control for the potential confounding effects of age, race, gender, and median household income by zip code.

Type 2 diabetes patients were about 30% less likely than type 1 diabetes patients to develop a urinary tract infection, pneumonia, or postoperative hemorrhage; they were about 50% less likely to develop an infection related to the surgery, said Dr. Bolognesi of Duke University, Durham, N.C.

Each of the differences they found between groups was statistically significant.

Perioperative urinary infections occurred in 5% of patients with type 1 diabetes and in 3% with type 2 diabetes. Pneumonia developed in 0.8% of the type 1 diabetes group and in 0.5% of the type 2 diabetes group.

Postoperative hemorrhage after total knee or hip arthroplasty was seen in 2% of the type 1 diabetes group and in 1% of the type 2 diabetes group. Infection occurred in 0.8% of patients with type 1 diabetes and in 0.4% with type 2 diabetes.

The mean length of stay in the hospital after total joint arthroplasty was 6 days in the type 1 diabetes group at a mean inflation-adjusted cost of $33,000, and 5 days in the type 2 diabetes group at a mean inflation-adjusted cost of $31,000.

Each of these differences between groups in the bivariate analysis was statistically significant.

There were no significant differences between groups in the rates of cerebrovascular accident, mental status changes, ileus, deep vein thrombosis, pulmonary embolism, thrombophlebitis, transfusion, other wound complications, or routine discharge.

“Total joint replacement is a highly effective treatment for degenerative hip and knee conditions, despite the presence of patient comorbidities,” Dr. Bolognesi said.

Diabetes increases the risk of perioperative complications, and the different underlying pathologies of the two types of diabetes may affect the perioperative risks, he added. “As diabetes and the need for hip and knee replacements both become more prevalent, an increasingly multidisciplinary approach to the care of these patients may be one answer for improving their clinical outcomes and health care resource utilization.”

Dr. Bolognesi reported that he is a consultant to four companies that market orthopedic products, instruments, or implants: ORTHOsoft Inc., DePuy Orthopaedics Inc., Zimmer Inc., and AMEDICA Corp. He owns stock or has stock options in two of those companies, and has received research funding and nonincome support, such as equipment, from three of them.