Key result
Pre-existing diabetic nephropathy linked to ~240% higher pulmonary edema risk during total knee arthroplasty.
Why the study?
The specific impact of diabetic nephropathy on perioperative complications following primary total knee arthroplasty has not been well-quantified in large-scale studies.
Does pre-existing diabetic nephropathy increase perioperative complications and resource utilization in patients undergoing primary total knee arthroplasty?
Cohort
Yes
Does pre-existing diabetic nephropathy increase perioperative complications and resource utilization in patients undergoing primary total knee arthroplasty?
Diabetic nephropathy is associated with significantly increased risks of perioperative medical and surgical complications, including a more than two-fold risk of acute myocardial infarction, following primary total knee arthroplasty.
PurposeWhile diabetic nephropathy (DN) is a known risk factor for poor outcomes in major surgery, its specific impact on perioperative complications following primary total knee arthroplasty (TKA) has not been well-quantified in large-scale studies. This study aimed to determine the correlation of pre-existing DN on perioperative complications, mortality, and healthcare resource utilization in patients undergoing primary TKA.MethodsA retrospective cohort study utilized the US National Inpatient Sample (2016-2019). Patients undergoing primary TKA were stratified into DN and non-DN cohorts using ICD-10 codes, excluding end-stage renal disease or revision cases. A 1:1 propensity score-matched analysis was performed to balance demographics, hospital characteristics, and 30 comorbidities between cohorts. Outcomes included surgical/medical complications, mortality, length of stay (LOS), and hospitalization costs. Multivariable logistic regression analyzed associations pre- and post-PSM.ResultsDN prevalence increased significantly from 1.2% (2016) to 3.4% (2019). After PSM, DN patients had significantly higher adjusted risks of multiple complications. Surgical complications included increased transfusion (aOR=1.64), intubation/mechanical ventilation (aOR=1.52), periprosthetic infection (aOR=1.38). Medical complications included pulmonary edema (aOR=3.40), acute myocardial infarction (aOR=2.13), stroke (aOR=1.43), atrial fibrillation/flutter (aOR=1.09), postoperative delirium (aOR=1.66), urinary retention (aOR=1.26), and urinary tract infection (aOR=1.25). Resource utilization significantly increased, with higher odds of extended LOS (aOR=1.44) and elevated hospitalization costs (aOR=1.19).ConclusionThese findings underscore that DN is significantly associated with a distinct pattern of TKA complications, advocating for targeted perioperative strategies to mitigate risks in this growing population.
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Cui et al. (2026) conducted a cohort in Primary total knee arthroplasty (TKA). Diabetic nephropathy vs. No diabetic nephropathy was evaluated on Perioperative complications, mortality, length of stay, and hospitalization costs. Pre-existing diabetic nephropathy in patients undergoing primary total knee arthroplasty was associated with increased risks of complications, including pulmonary edema (aOR 3.40).
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