2298-P: The Impact of Type 2 Diabetes and Obesity on Hospital Length of Stay after Total Knee Arthroplasty: A HCUP Study

Introduction and Objective: Increased hospital length of stay (LOS) is associated with higher healthcare costs and an increased risk of complications. Type 2 diabetes (T2DM) and obesity are common metabolic conditions associated with adverse surgical outcomes. This study evaluates whether, at the national level, the coexistence of T2DM and obesity, or either condition alone, is associated with longer LOS among adults undergoing total knee arthroplasty (TKA). Methods: A retrospective cohort study was performed using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample from 2017 to 2021. Adults undergoing TKA were identified using ICD-10 procedure codes and categorized into four groups: T2DM with obesity, obesity only, T2DM only, and neither condition, which was used as the reference group. Data were analyzed using a multivariate linear regression model, adjusted for confounding variables, and a secondary analysis evaluated the association between metabolic comorbidity and LOS. Results: Among 4,165 adults undergoing TKA, T2DM with obesity was associated with longer LOS (β = 1.26 days; 95% CI 0.82 - 1.70). T2DM alone was associated with an increased LOS (β = 0.43 days; 95% CI 0.05 - 0.82), whereas obesity alone was not. The presence of at least one metabolic comorbidity was associated with an increase in LOS exceeding half a hospital day (β = 0.52 days; 95% CI 0.30 - 0.75). Conclusion: These findings suggest that T2DM, particularly when combined with obesity, contributes to prolonged postoperative hospital LOS, underscoring the importance of optimizing the management of these conditions before undergoing a TKA. Beyond individual patient recovery, these extended hospitalization lengths have public health and economic implications when scaled nationally. In the setting of a high-volume elective procedure, these findings have further emphasized diabetes as a driver of cumulative inpatient burden and highlighted opportunities to improve healthcare delivery. Disclosure P.W. Musharbash: None. J. Torres: None. W. Worley: None. C. Young: Advisory Panel; Ended; Sanofi.