Impact of diabetic kidney disease on in-hospital complications and healthcare utilization following primary shoulder arthroplasty: a national database analysis

Shoulder arthroplasty (SA) is an established treatment for advanced shoulder disorders; however, its outcomes can be influenced by various comorbidities, particularly diabetic kidney disease (DKD). DKD, a combination of diabetes mellitus and renal dysfunction, may present unique challenges in the perioperative setting. This study examined the association between DKD on in-hospital complications and healthcare utilization following primary SA. A retrospective cohort study was conducted using the National Inpatient Sample (NIS) database, encompassing patients who underwent primary SA (including anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty) between 2018 and 2022. Patients with and without DKD were compared regarding demographic and hospital characteristics, preoperative comorbidities, postoperative complications, length of stay (LOS), and hospital charges. Propensity score matching was utilized to balance confounders between groups. The cohort consisted of 96,499 patients, with 2,576 (2.7%) diagnosed with DKD. In the matched cohort, DKD was associated with higher odds of acute renal failure, blood transfusions, genitourinary complications, and joint dislocation. Furthermore, DKD was associated with a longer LOS (median 2.0 vs. 1.0 days) and higher total hospital charges ($68,964.50 vs. $65,667.50, p < 0.001). Multivariate analysis confirmed these findings, with DKD patients showing significantly worse postoperative outcomes, including an increased risk of in-hospital complications and extended hospitalization. DKD was associated with a higher likelihood of several in-hospital complications and greater healthcare utilization following primary SA. These findings emphasize the need for careful preoperative assessment and tailored perioperative management for patients with DKD, particularly in relation to renal function, blood transfusion, and potential genitourinary issues. Further studies are required to evaluate long-term outcomes and the specific role of DKD in shoulder-specific complications. Level III; Retrospective cohort comparison using large database prognosis study.