Shoulder & Elbow

Diabetes and elbow replacement

Elbow arthroplasty is associated with significant complications if things go wrong. The poor soft-tissue envelope and often immunocompromised state of rheumatoid patients who most commonly require elbow replacement can sometimes result in significant and difficult to treat complications. What is not known is the effect that diabetes may have on the incidence and type of peri-operative complications. Using the US national inpatient sample data, researchers from Chicago (USA) retrospectively studied the outcomes of 3184 patients who underwent total elbow replacement.³ There were 488 patients with diabetes in the group. The groups were not quite matched and the diabetic group were older (66.8 vs 58.5 years), although there were no differences in length of stay, (4.1 vs 3.7 days) or cost of surgery ($56,582 vs $56,092). However, there were higher rates of complications including pneumonia (OR 2.7), urinary tract infection (OR 2.2), blood transfusion (OR 2.1) and complications on discharge (OR 1.9). However, some of these adverse events may be due to the higher comorbidity rates in the diabetes group. Consequentially the research team undertook a multivariant analysis to adjust for comorbidity confounders. Interestingly, this correction established that diabetes itself was not associated independently with increased length of hospital stay, cost or proportion of routine discharges. It seems from this data that diabetes itself does not increase the risks associated with elbow replacement although it does independently increase the risks of UTI, CVA and pneumonia, and patients should be warned of these risks.