Effect of Diabetes Mellitus on Perioperative Complications and Hospital Outcomes After Ankle Arthrodesis and Total Ankle Arthroplasty

Schipper, Oliver N.; Jiang, Jiaren; Chen, Lan; Koh, Jason L.; Toolan, Brian C.

doi:10.1177/1071100714555569

Cited by 58 publications

(52 citation statements)

References 13 publications

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“…In people with diabetes, surgery at the hip, knee, ankle, and elbow is associated with higher rates of post-operative infection, need for transfusion, pneumonia, urinary tract infection, length of stay, non-routine discharge, and in-hospital mortality [28, 29]. …”

Section: The Effect Of Diabetes and Its Complications On Peri-operatimentioning

confidence: 99%

Management of Hyperglycemia and Diabetes in Orthopedic Surgery

Akiboye

Rayman

2017

Curr Diab Rep

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An increasing number of orthopedic operations are being carried out in an older population in whom the prevalence of diabetes is dramatically increasing. People having surgery with diabetes and hyperglycemia are at increased risk of post-operative complications. The peri-operative risks have been well demonstrated for cardiac surgery and, more recently, for orthopedic surgery. This paper considers the issues surrounding orthopaedic surgery in patients with diabetes and the significance and management of hyperglycemia in the peri-operative period.

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Section: The Effect Of Diabetes and Its Complications On Peri-operatimentioning

confidence: 99%

Management of Hyperglycemia and Diabetes in Orthopedic Surgery

Akiboye

Rayman

2017

Curr Diab Rep

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“…However, the order was decided based on the biscuits' nutrient profile and glycaemic index, by first administering the biscuit type that would have the smallest carry-over effect on interstitial glucose levels from one day to the next. Furthermore, although the study was conducted in a relatively controlled hospital setting, post-surgery participants included patients undergoing a wide variety of surgical interventions (including total knee replacements, cardiac stents, gastrectomies, amputations, bowel resections and laminectomies), which could represent potential confounders to our results considering the varying complexity of each procedure and the effect of different types of surgery on glycaemic control [6,[36][37][38][39]. Given the above, all statistical analyses were repeated after excluding the four patients enrolled in the study following gastrointestinal operations.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with T2DM are often over-represented in hospital inpatient populations due to diabetic complications [3]. Moreover, patients having surgery with co-morbid T2DM and dysglycaemia (i.e., hyperglycaemia, hypoglycaemia, or excessive variability in glucose levels) are at increased risk of perioperative complications, such as the need for transfusion, pneumonia, delayed discharge, surgical infections and in-hospital mortality [4][5][6][7][8]. Treating hyperglycaemia in the peri-operative period has been shown to reduce complications in several surgical disciplines [4].…”

Section: Introductionmentioning

confidence: 99%

Effect of Lupin-Enriched Biscuits as Substitute Mid-Meal Snacks on Post-Prandial Interstitial Glucose Excursions in Post-Surgical Hospital Patients with Type 2 Diabetes

et al. 2020

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Hospital biscuit snacks offered to Type 2 Diabetes Mellitus (T2DM) patients may adversely affect glycaemic control. This study investigated the effect of lupin mid-meal biscuit snacks, compared to spelt or standard hospital biscuits, on interstitial glucose levels in post-operative T2DM inpatients. In a pilot cross-over pragmatic study, 20 patients (74 ± 12 years) consumed, in order, lupin biscuits (20% lupin), wholemeal spelt and standard plain sweet biscuits as mid-meal snacks (2 biscuits each for morning and afternoon tea) on three consecutive days. Continuous glucose monitoring, appetite perceptions and bowel motions were recorded. Glucose levels were not significantly different in the first 90 min after mid-meal biscuit consumption at morning and afternoon tea, irrespective of type. However, after consuming the lupin biscuits only, glucose levels were significantly (p < 0.001) reduced 90 min postprandially after dinner, indicating a potential second-meal effect. Patients also reported improved satiety after lupin biscuit consumption on day 1, compared to days 2 and 3 (p = 0.018). These findings suggest that lupin-enriched biscuits may improve both glycaemic control and satiety in hospitalised T2DM patients, potentially contributing to reduced length of stay. Larger controlled studies are warranted to confirm these findings and inform potential revision of hospital menu standards for T2DM patients.

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“…Klasan et al retrospectively analyzed risk factors for transfusion in patients undergoing both primary THA and TKA and found that diabetes mellitus was a risk factor for blood transfusion. 49 When examining the orthopaedic literature as a whole, diabetes has been reported as a risk factor for blood transfusion in spine surgery, 50,51 ankle surgery, 52 and elbow procedures. 53 However, in other reports on spine surgery, diabetes was found not to increase the risk for transfusion.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

Lee

Fassihi

et al. 2020

The Journal of Hip Surgery

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Revision total hip arthroplasty (rTHA) is associated with significant intraoperative blood loss requiring transfusion. Given that blood transfusions increase the risk of numerous complications, efforts should be made to determine which patients are at high risk of transfusion and optimize them appropriately. This study aimed to identify independent risk factors associated with blood transfusion in patients undergoing rTHA for mechanical failure. A multi-institutional surgical registry was queried for all patients who underwent rTHA for mechanical failure from 2005 to 2016. Patients were divided into transfused and nontransfused cohorts and underwent univariate analysis for differences in demographic features, preoperative comorbidities, and operative variables. Multivariate regression models were generated to elucidate independent risk factors associated with perioperative blood transfusions. A total of 8,469 rTHA patients met inclusion and exclusion criteria, of which 1,863 (22.0%) received blood transfusions within 72 hours postoperatively. On multivariate logistic regression analysis, age ≥ 65 years (odds ratio [OR] 1.313; p < 0.001), female gender (OR 1.465; p < 0.001), insulin-dependent diabetes mellitus (OR 1.503; p = 0.003), chronic obstructive pulmonary disease (COPD; OR 1.307; p = 0.030), hypertension (OR 1.359; p < 0.001), hematologic disorders (OR 1.565; p < 0.001), preoperative blood transfusions (OR 3.851; p < 0.001), systemic sepsis (OR 2.277; p = 0.003), functional dependence (OR 1.416; p = 0.003), open wounds/wound infections (OR 2.878; p < 0.001), and operations lasting at least 175 minutes (OR 4.841; p < 0.001) were all significant independent risk factors for blood transfusions. Obesity (body mass index [BMI] ≥ 30 kg/m2; OR 0.818; p = 0.001), smoking history (OR 0.800; p = 0.014), and isolated acetabular component revision (OR 0.730; p < 0.001) were associated with a decreased risk of blood transfusion. Older age, female gender, lower BMI, absence of smoking history, functional dependence, insulin-dependent diabetes mellitus, hypertension, revision of the femoral component, preoperative transfusion, hematologic disorders, sepsis, open wounds/wound infections, COPD, and longer operative time were all independent risk factors for blood transfusions in rTHA performed for mechanical failure. By identifying these risk factors, clinicians can identify and optimize high-risk patients to minimize blood transfusion requirements, thereby reducing the risk of transfusion-associated complications in this patient population.

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Effect of Diabetes Mellitus on Perioperative Complications and Hospital Outcomes After Ankle Arthrodesis and Total Ankle Arthroplasty

Abstract: After both AAD and TAA, diabetes mellitus was independently associated with a significantly increased risk of perioperative complications, nonhome discharge, and length of hospital stay during the index hospitalization.

Cited by 58 publications

References 13 publications

Management of Hyperglycemia and Diabetes in Orthopedic Surgery

Management of Hyperglycemia and Diabetes in Orthopedic Surgery

Effect of Lupin-Enriched Biscuits as Substitute Mid-Meal Snacks on Post-Prandial Interstitial Glucose Excursions in Post-Surgical Hospital Patients with Type 2 Diabetes

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

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