Total knee arthroplasty (TKA) is a common and effective treatment of knee osteoarthritis. As the amount of TKAs performed increases, so does the number of TKA failures and subsequent revisions. Diabetes mellitus (DM) has been shown to increase complications following orthopaedic procedures. For these reasons, it is important to understand the association between severity of DM and the risk of postoperative adverse events following revision TKA. A retrospective cohort study was conducted using the American College of Surgeons' National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2007 and 2016 were identified and recorded as having noninsulin-dependent DM (NIDDM), insulin-dependent DM (IDDM), or no DM. Univariate and multivariate analysis were used to evaluate the incidence of multiple adverse events within 30 days after revision TKA. A total of 13,246 patients who underwent revision TKA were selected (without DM = 10,381 [78.4%]; NIDDM = 1,890 [14.3%]; IDDM = 975 [7.4%]). Patients with NIDDM were found to have an increased risk of developing renal insufficiency and urinary tract infection (UTI) compared with patients without DM, while patients with IDDM were found to have an increased risk of developing 10 of 20 adverse events compared with patients without DM. NIDDM is an independent risk factor for UTI and IDDM is an independent factor for development of three complications compared with no DM. Insulin dependency is an independent factor for septic shock, postoperative blood transfusion, and extended postoperative hospital stay. Relative to patients with NIDDM, those with IDDM have a greater likelihood of developing more adverse perioperative outcomes than patients without DM. Although complication rates remain relatively low, orthopaedic surgeons must consider the implications of diabetes and insulin dependence on patient selection, preoperative risk stratification, and postoperative outcomes.

To analyze the interaction between the route of hysterectomy for benign disease and postoperative morbidity among patients stratified by body mass index (BMI) and to test for a dose-dependent relationship between obesity severity and postoperative morbidity. Design: A retrospective cohort study. Patients: Benign hysterectomy cases were abstracted from the American College of Surgeons National Safety and Quality Improvement Program from 2005 to 2016. Cancer and prolapse surgeries were excluded by corresponding International Classification of Diseases and Current Procedural Terminology codes. Interventions: Laparoscopic hysterectomy.Measurements and Main Results: Associations between BMI, route of surgery, and categoric patient variables were examined using the chi-square test. Associations of BMI, route of surgery, and continuous patient variables were examined using 1-way analysis of variance. Associations of the route of surgery with binary outcomes were examined within BMI categories using the chi-square or Fisher exact test. Logistic regression and interaction tests were used for final outcomes of interest. There were 159 025 patients in the collected sample. Patients who underwent an abdominal hysterectomy had higher odds of composite morbidity if they were obese; the adjusted odds were 17% higher for class 1 obesity, 55% higher for class 2 obesity, and 163% higher for class 3 obesity. An abdominal hysterectomy was associated with worse postoperative outcomes when compared with a laparoscopic hysterectomy (p <.001). The risk of increased composite postoperative morbidity for patients undergoing a laparoscopic hysterectomy was not significantly different from the reference group until women had class 3 obesity; the odds of composite morbidity for class 3 obesity women become 31% higher than for nonobese patients. Conclusion: BMI directly impacts postoperative morbidity for both abdominal and laparoscopic hysterectomies although the effect is more pronounced after an abdominal hysterectomy. Roughly 40% of women undergoing a hysterectomy in the United States are obese. These data should motivate surgeons to consider ways to medically and surgically optimize patients, including weight reduction before hysterectomy and choosing a laparoscopic approach whenever possible to lower the risk of postoperative morbidity.

<b><i>Background:</i></b> Current research pertaining to minimally invasive gynecologic surgical outcomes in the context of diabetes mellitus (DM) is limited. This study seeks to evaluate the association between DM and postoperative complications following laparoscopic hysterectomy for benign indications. <b><i>Methods:</i></b> The American College of Surgeons National Surgical Quality Improvement Program database was utilized. We identified laparoscopic hysterectomies completed for benign indications from 2007 to 2016 using current procedural terminology codes. Complications were evaluated by DM status: non-insulin-dependent DM (NIDDM), insulin-dependent DM (IDDM), and non-DM. Postoperative complications were evaluated utilizing univariate and multivariate analyses. <b><i>Results:</i></b> We identified 56,640 laparoscopic hysterectomies. Though both the IDDM and NIDDM cohorts had an increased incidence of postoperative complications compared to the non-diabetes cohort. The IDDM group had the highest incidence of all 3 cohorts. Compared to non-DM, the IDDM group had higher odds of reintubation (OR 4.23; 95% CI 1.59–11.19), urinary tract infection (OR 1.45; 95% CI 1.022–2.069), and extended length of stay (OR 1.75; 95% CI 1.36–2.26). <b><i>Conclusion:</i></b> Both NIDDM and IDDM were independent risk factors for postoperative complications after laparoscopic hysterectomy. However, the IDDM cohort had the highest odds of complications. Diabetic patients should be carefully counseled regarding their elevated risk of perioperative complications.

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To examine the impact of perioperative allogeneic blood transfusion (ABT) on postoperative infectious wound occurrences, sepsis-related events. and venous thromboembolism. Design: Retrospective cohort study. Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Patients: Patients who underwent a minimally invasive hysterectomy for benign indications between 2012 and 2016 were selected from the ACS-NSQIP. Patients with concurrent open hysterectomy, prolapse, or malignancy were excluded. Those with preoperative, intraoperative or postoperative red blood cell transfusion were considered positive for perioperative ABT. Intervention: Minimally invasive hysterectomy for benign indications. Measurements and Main Results: Univariate analyses were performed to determine associations of preoperative and intraoperative patient variables and postoperative outcomes with perioperative ABT. Multivariate analysis was completed to test the independent associations of perioperative ABT with outcomes while adjusting for possible confounders. Of the 90,231 patients who met our inclusion criteria, 1447 had a perioperative transfusion (1.6%). Perioperative ABT was associated with multiple preoperative variables. After multivariate analysis, perioperative ABT remained significantly associated with infectious wound events (adjusted odds ratio [aOR], 1.96; 95% confidence interval [CI], 1.9−2.58; p < .001), thromboembolic events (aOR, 2.75; 95% CI, 1.5−5.05; p = .001), and sepsis events (aOR, 6.49; 95% CI, 4.29−9.79, p < .001). Conclusion:ABT is a commonly used to treat perioperative anemia in patients undergoing gynecologic surgery. The results of this study, however, show that perioperative ABT increases a patient's risk of postoperative complications following minimally invasive hysterectomy. Gynecologic surgeons should consider the use of alternative treatments for perioperative anemia, including intravenous iron supplementation, erythropoiesis-stimulating agents, normovolemic hemodilution, and preoperative hormonal suppression, to help reduce the morbidity associated with perioperative ABT.