Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty Brent A. Ponce, MD a, *, Mariano E. Menendez, MD a,b , Lasun O. Oladeji, MS a , Francisco Soldado, MD, PhD b a Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA b Department of Orthopaedic Surgery, Universitat Aut onoma de Barcelona, Barcelona, Spain Background: Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty, its impact on early postoperative outcomes after shoulder replacement re- mains relatively unexplored. The purpose of the study was to determine the association of diabetes with in- hospital death, complications, length of stay, non-homebound disposition, and cost in patients undergoing shoulder arthroplasty. Methods: By use of the Nationwide Inpatient Sample database for the year 2011, an estimated 66,485 pa- tients having undergone shoulder arthroplasty were identified and separated into groups with (21%) and without (79%) diabetes mellitus. Comparisons of specific outcome measures between diabetic and nondi- abetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling. Results: Diabetes mellitus was independently associated with in-hospital death, a number of perioperative complications, prolonged hospital stay, and increased non-homebound disposition after shoulder arthro- plasty. The presence of diabetes was not associated with increased hospital cost. Conclusion: Patients with preexisting diabetes are at higher risk for perioperative morbidity and mortality after shoulder arthroplasty. Future prospective research should explore in more detail the relationship be- tween diabetes and shoulder arthroplasty outcomes. Level of evidence: Level II, Retrospective Design, Prognosis Study. Ó 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Diabetes; shoulder arthroplasty; perioperative; complication Diabetes mellitus is a multisystem disorder associated with premature death and presently constitutes a concern- ing health problem worldwide. 13,15,20,49 Currently, half of the patients with diabetes are older than 60 years, making this clinical entity an important factor to consider in arthroplasty surgery planning. 32 The national prevalence of diabetes mellitus is rising at an alarming rate, driven by the obesity epidemic and sedentary lifestyles in industrialized countries and by an ever-expanding aging population. 13,20,31,34,42,49,50 In 2010, an estimated 18.8 million people in the United States were diagnosed with diabetes mellitus 11 ; these numbers are ex- pected to reach 30 million by 2030. 50 Lifestyle modifica- tions, such as regular physical activity, are of paramount importance in the management of diabetes. 10 Concomitant Our Institutional Review Board has determined that this study is exempt from IRB review. The data are de-identified and commercially available online. *Reprint requests: Brent A. Ponce, MD, Division of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Suite 203, Birmingham, AL 35205, USA. E-mail address: bponce@uabmc.edu (B.A. Ponce). J Shoulder Elbow Surg (2014) 23, 671-678 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.2014.01.046