Influence of diabetes on the risk of deep vein thrombosis of patients after total knee arthroplasty: a meta-analysis.

ABSTRACT

BACKGROUND: Previous studies evaluating the influence of diabetes on the risk of deep vein thrombosis (DVT) after total knee arthroplasty (TKA) showed inconsistent results. The aim of the study was to systematically evaluate the association between diabetes and DVT after TKA in a meta-analysis. METHODS: An extensive search was conducted in PubMed, Embase, and Web of Science to identify relevant cohort studies. Random-effects models were employed to pool the results after taking account of the potential influence of heterogeneity. RESULTS: Thirteen cohort studies involving 546,156 patients receiving TKA were included, with 71,110 (13.0%) diabetic patients before surgery and 1479 (2.1%) patients diagnosed as DVT after surgery. Overall, diabetes was associated with an increased risk of DVT after TKA (risk ratio [RR] 1.43, 95% confidence interval [CI] 1.12-1.84, p = 0.004; I2 = 44%). Sensitivity analysis limited to studies with chemoprophylaxis (RR 1.96, 95% CI 1.50-2.54), and studies with multivariate analysis (RR 1.54, 95% CI 1.12-2.11) showed consistent results. Subgroup analysis showed that diabetes was associated with higher risk of postoperative DVT in Asian countries (RR 1.93, 95% CI 1.49-2.52, p < 0.001; I2 = 1%) but not in Western countries (RR 1.07, 95% CI 0.86-1.34, p = 0.52; I2 = 0%; p for subgroup difference < 0.001). CONCLUSION: Diabetes may be a risk factor for DVT after TKA, even with the chemoprophylaxis of anticoagulants. The association between diabetes and DVT after TKA may be more remarkable in patients from Asian countries.