Revision total hip arthroplasty (rTHA) is becoming a more common procedure due to the increasing volume of primary total hip arthroplasty. Diabetes mellitus (DM) is currently projected to affect 4.4% of the global population by 2030. Diabetes has been associated with poor outcomes for a variety of surgical interventions. However, the impact of insulin dependence has yet to be fully understood. The aim of this study was to determine the impact of insulin dependence on acute postoperative complications following rTHA.
A retrospective cohort study was conducted using the American College of Surgeons National Quality Improvement Program database. All patients who underwent rTHA between 2006 and 2016 were identified and recorded as having non-insulin-dependent DM (NIDDM), insulin-dependent DM (IDDM) or no DM. Univariate and multivariate analysis were used to evaluate the incidence of multiple adverse events within 30 days after rTHA.
A total of 7685 patients were evaluated (No DM = 6651, NIDDM = 700, IDDM = 334). Univariate analysis revealed that all patients with DM had significantly higher incidences of postoperative complications (NIDDM:  < 0.001; IDDM:  < 0.001) and extended hospital length of stay (NIDDM:  = 0.015; IDDM:  < 0.0001). NIDDM was associated with increased rates of superficial surgical site infection (SSI) ( = 0.001), deep SSI ( = 0.038), and stroke ( = 0.013), while IDDM was associated with increased rates of pneumonia ( < 0.001), renal failure ( < 0.001), and postoperative transfusion ( < 0.001). On multivariate analysis, insulin-dependence was determined to be an independent risk factor for extended hospital length of stay (OR 1.905; 95% CI, 1.410-2.577;  < 0.001), pneumonia (OR 4.016; 95% CI, 1.799-8.929;  = 0.001), renal failure (OR 7.143; 95% CI, 2.203-23.256;  = 0.001) and postoperative transfusion (OR 1.366; 95% CI, 1.076-1.733;  = 0.01).
Insulin dependence is an independent risk factor for numerous short-term postoperative complications following rTHA. When assessing risk and planning perioperative management, surgeons should consider insulin-dependent diabetics as a sub-cohort within the diabetic population.