Comparison of perioperative complications after total elbow arthroplasty in patients with and without diabetes Aneet S. Toor, MD a , Jimmy J. Jiang, MD a , Lewis L. Shi, MD a , Jason L. Koh, MD b, * a Department of Orthopaedic Surgery, University of Chicago Medical Center, Chicago, IL, USA b Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, IL, USA Background: Few studies have analyzed the effect of diabetes on outcomes after total elbow arthroplasty (TEA). We investigated the perioperative complications after TEA in patients with and without diabetes. Methods: We evaluated the Nationwide Inpatient Sample (NIS) database from 2005 to 2010 for patients who underwent a TEA. Our retrospective study included 3184 patients based on International Classifica- tion of Diseases-Ninth Revision, Clinical Modification codes. We compared outcomes in 488 patients with diabetes and in 2696 patients without diabetes. Results: Patients with diabetes had a significantly older mean age (66.8 vs 58.5 years, P < .001). There was no statistically significant difference when comparing length of stay (4.1 vs 3.7 days, P ¼ .056) and cost of surgery ($56,582 vs $56,092, P ¼ .833). A significantly higher percentage of diabetic patients un- derwent TEA for the indication of fracture (73.4% vs 65.3%), but a lower percentage for rheumatoid arthritis (10.2% vs 19.2%). They also had significantly increased rates of pneumonia (odds ratio [OR], 2.7), urinary tract infection (OR, 2.2), blood transfusion (OR, 2.1), and nonroutine discharge (OR, 1.9). After adjusting for significantly increased rates of comorbidities in diabetic patients, our multivariate anal- ysis showed that having diabetes was independently associated with an increased risk of pneumonia (rela- tive risk [RR], 2.6), urinary tract infection (RR, 1.9), and cerebrovascular accident (RR, 9.1). However, diabetes was not independently associated with hospital length of stay (P ¼ .75), after correction, hospital cost (P ¼ .63), or proportion of routine discharges (P ¼ .12). Conclusion: Patients with diabetes have higher rates of comorbidities and perioperative complications after TEA. Level of evidence: Level III, Retrospective Cohort Design, Treatment Study. Ó 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Total elbow arthroplasty; diabetes; perioperative outcome; complication The prevalence of diabetes mellitus continues to in- crease due to increasing rates of obesity and life expec- tancy. Diabetes has direct deleterious effects on the vascular and immune systems, making it more difficult for patients with diabetes to recover from common illnesses and in- juries. 11,19,20 Recent studies have shown the prevalence of diabetes peaks in the age group of 60 to 74 years. 6 This is This study was approved for exempt status by the University of Chicago Biological Sciences Division Investigational Review Board (Protocol No. IRB 13-1065). *Reprint requests: Jason L. Koh, MD, Department of Orthopaedic Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Wal- green’s 2505, Evanston, IL 60201, USA. E-mail address: kohj1@hotmail.com (J.L. Koh). J Shoulder Elbow Surg (2014) -, 1-8 www.elsevier.com/locate/ymse 1058-2746/$ - see front matter Ó 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2014.06.045