DOS 2020

94 · DOS Abstracts Postoperative morbidity and mortality in diabetic patients after fast-track hip and knee arthroplasty – a prospective follow-up cohort of 36,762 procedures Milla Ortved, Pelle Baggesgaard Petersen, Christoffer Calov Jørgensen, Henrik Kehlet, on behalf of the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group Section for Surgical Pathophysiology, Rigshospitalet Background: Diabetes mellitus (DM) increases risk of adverse outcome in surgical procedures including total hip and knee arthroplasty (THA/TKA) with prevalence ranging from approximately 8-20%. However, there is still a need to clarify the role of diabetes and antihyperglycemic treatment in a fast-track THA/TKA setting which otherwise may decrease morbidity. Purpose / Aim of Study: Consequently, we investigated the effect of diabe- tes and antihyperglycemic treatment on length of stay (LOS) and complications following fast-track THA/TKA within a multicenter fast-track collaboration. Materials and Methods: Observational study design on data from a prospec- tive multicenter fast-track collaboration on unselected elective primary THA/ TKA from 2010 to 2017. Complete follow-up (>99 %) was achieved through The Danish National Patient Registry and types of complications leading to LOS > 4 days, 90- day readmission or mortality obtained by scrutinizing health re- cords and discharge summaries. Findings / Results: 36,762 procedures were included of which 837 (2.3%) had insulin-treated DM, 2615 (7.1%) orally treated DM, and 566 (1.5%) di- etary treated DM. Median LOS was 2 (IQR: 1-3) days. More diabetic (14.7% for insulin treated and 9.4% for orally treated DM, p <0.001) than non-diabetic patients (6.0%), had LOS > 4 days. This association remained significant af- ter adjustment for comorbidities insulin-treated (OR 2.2; 99.6% CI[1.3-3.7]; p <0.001) and orally-treated (1.5 [1.0–2.1]; p =0.002). Insulin-treated was independently associated with increased odds of “diabetes related” morbidity (OR 2.3[1.2–4.2]; p <0.001). DM had increased renal complications regard- less of antihyperglycemic treatment, but only insulin-treated patients suffered significantly more cardiac complications. There was no increase in periprosthetic joint infections or mortality associated with DM. Conclusions: Patients with pharmacologically treated DM undergoing fast- track THA/TKA were at increased risk of LOS > 4 days. Although complica- tion rates were low, patients with insulin-treated DM where at increased risk of postoperative complications. Further investigation into the pathogenesis of postoperative complications differentiated by antihyperglycemic treatment is needed. 80.