Preoperative Metformin Not the Blame for Increased Complications After Rotator Cuff Repair in Diabetic Population
Alexander M Dawes, BS1, Roy J Toston, BS2, John T Hurt, BS1, Michael B. Gottschalk, MD1 and Eric R. Wagner, MD1, (1)Emory University, Atlanta, GA, (2)Emory University, ATLANTA, GA
Introduction: Studies have found that diabetic patients undergoing rotator cuff repair are often twice as likely to experience complications following surgery. Our study evaluates the association of this increased complication rate with preoperative use of Metformin, a common drug utilized in the management of diabetic patients electing to undergo rotator cuff repair.
Methods: This study utilizes the Truven Marketscan Health Analytics database, a large national claims database with over one million records. This study selected diabetic patients undergoing elective rotator cuff repair surgery from 2009-2018 who had continuous enrollment on their insurance for 1 year preoperatively and 6 months postoperatively. Patient outpatient pharmacy claims were utilized to obtain insulin and metformin status and patients were defined as users of each drug if they had at least two prescriptions filled prior to surgery. Statistical analysis was performed to identify increased odds ratios for surgical complications with respect to Metformin use and Metformin use when insulin dependence is stratified.
Results: A total of 9,437 diabetic patients undergoing elective surgery for rotator cuff repair were identified with 38.7% (n=3,350) of those using Metformin (Table 1). Upon Multivariate analysis a decreased odds ratio was identified for surgical site infection for those patients taking Metformin (Table 2). Of the 38.7% of patients taking Metformin, 19.2% (n=644) were Insulin dependent (Table 3). Further multivariate analysis comparing outcomes of insulin-dependent Metformin users to non-insulin-dependent users of the drug revealed a sole increase in odds for Emergency Department visit (Table 4).
Conclusion: When planning for elective surgical repair of the rotator cuff, consideration must be directed to care of diabetic patients who have been shown to have higher postoperative complication rates. Our study demonstrates that preoperative Metformin use is not associated with increased complications and may offer protective benefits to this patient population.
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