Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty

Ponce, Brent A.; Menendez, Mariano E.; Oladeji, Lasun O.; Soldado, Francisco

doi:10.1016/j.jse.2014.01.046

Cited by 80 publications

(66 citation statements)

References 50 publications

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“…Additional data recorded include patient-and provider-related characteristics and hospitalization outcomes such as discharge disposition and length of stay. The NIS database has been regularly used for comparative health services research since its inception in 1988 [23,34]. Institutional review board approval was not required for this study, because the data contained no personal identifiers.…”

Section: Methodsmentioning

confidence: 99%

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

Menendez

Dijk

Ring

2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients who leave the hospital against medical advice are at risk for readmission and for a variety of complications and are likely to consume more healthcare resources. However, little is known about which factors, if any, may be associated with self-discharge (discharge against medical advice) among orthopaedic inpatients. Questions/purposes We studied the frequency and factors associated with self-discharge in patients hospitalized for orthopaedic trauma and musculoskeletal infection. Methods Using discharge records from the Nationwide Inpatient Sample (2002-2011), we identified approximately 7,067,432 patient hospitalizations for orthopaedic trauma and 5,488,686 for musculoskeletal infection. We calculated the proportions of admissions that ended in selfdischarge for both trauma and infection patients; then, we examined patient demographics, diagnoses, and hospital factors. Multivariable logistic regression models were constructed to determine independent predictors of selfdischarge. Results Approximately one in 333 (0.3%) patients hospitalized for an isolated fracture and one in 47 (2.1%) patients with musculoskeletal infection left against medical advice. Patient characteristics associated with self-discharge included age \ 75 years (trauma: odds ratio [OR] 2.7, 95% confidence interval [CI] 2.5-2.8, p \ 0.001; infection: OR 3.9, 95% CI 3.8-4.1, p \ 0.001), male sex (trauma: OR 1.7, 95% CI 1.7-1.8, p\0.001; infection: OR 1.4, 95% CI 1.3-1.4, p \ 0.001), black race/ethnicity (trauma: OR 1.5, 95% CI 1.4-1.6, p\0.001; infection: OR 1.1, 95% CI 1.1-1.1, p \ 0.001), low household income (trauma: OR 1.5, 95% CI 1.4-1.5, p\0.001; infection: OR 1.4, 95% CI 1.4-1.4, p \ 0.001), nonprivate insurance (Medicare [trauma: OR 1.7, 95% CI 1.6-1.8, p \ 0.001; infection: OR 2.5, 95% CI 2.4-2.5, p \ 0.001] and Medicaid [trauma: OR 2.6, 95% CI 2.5-2.7, p \ 0.001; infection: OR 3.2, 95% CI 3.2-3.3, p \ 0.001]), and no insurance coverage (trauma: OR 3.0, 95% CI 2.9-3.1, p \ 0.001; infection: OR 3.5, 95% CI 3.4-3.5, p \ 0.001), less medical comorbidity (trauma: OR 0.94 per one-unit increase in the number of comorbidities, 95% CI 0.93-0.95, p\0.001; infection: OR 0.88, 95% CI 0.87-0.88, p\ 0.001), alcohol (trauma: OR, 2.3, 95% 2.2-2.4, p \ 0.001; infection: OR 1.5, 95% CI 1.5-1.5, p \ 0.001), opioid (trauma: OR 2.9, 95% CI 2.7-3.1, p\0.001; infection: OR 4.4, 95% CI 4.3-4.4, p \ 0.001) and nonopioid drug abuse (trauma: OR, 2.0, 95% CI 1.9-2.1, p \ 0.001; infection: OR 2.8, 95% CI 2.8-2.9, p \ 0.001), psychosis (trauma:Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. 3, 95%CI 1.2-1.3, p\0.001; infection: OR 1.3, 95% CI 1.3, 1.4, p \ 0.001), and AIDS/HIV infection (trauma: OR 1.5, 95% CI 1.2-1.8, p\0.001; infection: OR 1.3, 95% CI 1.3-1.4, p \ 0.001). Patients with upper...

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Section: Methodsmentioning

confidence: 99%

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

Menendez

Dijk

Ring

2015

Clinical Orthopaedics &Amp; Related Research

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“…50 Previous work has highlighted that administrative databases may fail to accurately report chronic medical conditions perioperatively in the orthopedic surgical setting. 19, [35][36][37]40 Unfortunately, the NIS is dependent on the ICD-9 classification system; therefore, there were no details accompanying the database information. Because of the sheer volume of data contributing to the NIS, there is a 2-year lag between data collection and availability.…”

Section: And Shouldermentioning

confidence: 99%

Comparative analysis of anatomic and reverse total shoulder arthroplasty: in-hospital outcomes and costs

Ponce

Oladeji

Rogers

et al. 2015

Journal of Shoulder and Elbow Surgery

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“…Perioperative hyperglycemia during major surgery has a significant impact on the occurrence of postoperative complications, including various infections, impaired wound healing, and myocardial infarction. 6,7,[15][16][17] Treating perioperative hyperglycemia has been shown to reduce postoperative infections. 15,18 The underlying pathophysiologic mechanisms by which hyperglycemia leads to an increase in deleterious outcomes have not yet been fully elucidated.…”

Section: Perioperative Hyperglycemia and Complicationsmentioning

confidence: 99%

“…36 As stated before, hyperglycemia during major surgery is associated with adverse outcomes. 6,[15][16][17] In a prospective cohort study in ambulatory patients, DM was found to be a risk factor for postoperative complications after minor ambulatory surgery, such as postoperative infections or unplanned admissions. 10 Hyperglycemia (glucose .7.…”

Section: Perioperative Hyperglycemia and Complicationsmentioning

confidence: 99%

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Polderman¹,

Wilpe²,

Eshuis³

et al. 2016

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Given the growing number of patients with diabetes mellitus (DM) and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery.

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Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty

Cited by 80 publications

References 50 publications

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

Comparative analysis of anatomic and reverse total shoulder arthroplasty: in-hospital outcomes and costs

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

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