Berkovich Yaara, Nissan Ela Cohen, Maman David, Hirschmann Michael Tobias, Yonai Yaniv, Steinfeld Yaniv, Berkovich Yaron
Technion Israel Institute of Technology, Haifa, Israel.
Department of Orthopedics, Carmel Medical Center, Haifa, Israel.
Knee Surg Sports Traumatol Arthrosc. 2025 Sep;33(9):3250-3260. doi: 10.1002/ksa.12696. Epub 2025 May 12.
Total knee arthroplasty (TKA) is a frequently performed surgical procedure aimed at reducing pain, improving mobility, and restoring function in patients with advanced knee osteoarthritis. As patients undergoing TKA age, the prevalence of comorbidities, particularly diabetes, continues to rise. This study assesses post-operative complications, healthcare costs and hospital length of stay (LOS) among diabetic patients undergoing primary and revision TKA using nationwide data from the NIS database, employing propensity score matching (PSM) to minimize confounding variables. We hypothesized that diabetic patients undergoing TKA would experience higher complication rates, greater healthcare costs and longer hospital stays compared to non-diabetic controls.
This retrospective cohort analysis utilized data from the Nationwide Inpatient Sample from 2016 to 2019, including a total of 2,602,484 TKA patients: 561,340 with type 2 diabetes and 2,041,144 without diabetes. PSM was applied to create balanced cohorts, adjusting for baseline demographic and clinical differences. Outcomes analyzed included LOS, total hospitalization charges, post-operative complications and revision surgery rates. Statistical significance was set at p < 0.05.
Following PSM, diabetic patients exhibited significantly higher risks for post-operative complications, including sepsis, heart failure and surgical site infections, compared to matched non-diabetic controls. Diabetic patients also incurred significantly greater hospital charges ($64,694 vs. $59,952, p < 0.001). In revision TKA cases, diabetic patients demonstrated slightly longer LOS (3.5 days vs. 3.0 days, p < 0.001) and higher total hospital charges ($101,457 vs. $96,614, p = 0.015).
Diabetic patients undergoing TKA experience significantly higher complication rates, hospital charges and revision surgery burden. Orthopaedic surgeons and perioperative teams should implement personalized perioperative management strategies, including optimized glycaemic control, cardiovascular risk assessment and infection prevention measures, to mitigate these risks and improve clinical outcomes.
Level III.
全膝关节置换术（TKA）是一种常见的外科手术，旨在减轻晚期膝关节骨关节炎患者的疼痛、改善活动能力并恢复功能。随着接受TKA手术的患者年龄增长，合并症的患病率，尤其是糖尿病的患病率持续上升。本研究利用国家住院样本（NIS）数据库中的全国性数据，采用倾向得分匹配（PSM）方法以尽量减少混杂变量，评估接受初次和翻修TKA手术的糖尿病患者的术后并发症、医疗费用和住院时间（LOS）。我们假设与非糖尿病对照组相比，接受TKA手术的糖尿病患者将经历更高的并发症发生率、更高的医疗费用和更长的住院时间。
这项回顾性队列分析利用了2016年至2019年全国住院样本的数据，共纳入2,602,484例TKA患者：561,340例2型糖尿病患者和2,041,144例非糖尿病患者。应用PSM创建平衡队列，以调整基线人口统计学和临床差异。分析的结果包括住院时间、总住院费用、术后并发症和翻修手术率。设定统计学显著性为p < 0.05。
PSM后，与匹配的非糖尿病对照组相比，糖尿病患者术后并发症的风险显著更高，包括败血症、心力衰竭和手术部位感染。糖尿病患者的住院费用也显著更高（64,694美元对59,952美元，p < 0.001）。在翻修TKA病例中，糖尿病患者的住院时间略长（3.5天对3.0天，p < 0.001），总住院费用更高（101,457美元对96,614美元，p = 0.015）。
接受TKA手术的糖尿病患者经历的并发症发生率、住院费用和翻修手术负担显著更高。骨科医生和围手术期团队应实施个性化的围手术期管理策略，包括优化血糖控制、心血管风险评估和感染预防措施，以减轻这些风险并改善临床结果。
III级。
