Perioperative hyperglycaemia and incidence of post-operative complications in patients undergoing total knee arthroplasty

Reátegui, Diego; Sánchez‐Etayo, G.; Núñez, Esther; Tió, M.; Popescu, Dragos; Núñez, Monserrat; Lozano, Luís

doi:10.1007/s00167-014-2907-7

Cited by 31 publications

(31 citation statements)

References 31 publications

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“…A previous study found an association between HbA 1c levels C 8 and wound complications but no association with early postoperative deep infection in patients with DM after TKA [6]. On the other hand, our finding of the only association of preoperative FBG C 200 mg/dL with superficial surgical site infection is in contrast with previous studies reporting the association of preoperative FBG level C 126 mg/dL [9], postoperative FBG level C 126 mg/dL [21], and postoperative FBG level C 200 mg/dL [16] with the occurrence of complications after total joint arthroplasty. Our findings, taken together with previous studies, suggest that surgeons should think carefully before performing this elective procedure in a patient with HbA 1C C 8 or FBG C 200 mg.…”

Section: Discussioncontrasting

confidence: 99%

“…Prior studies have suggested that patients with DM undergoing TKA have a higher likelihood of wound complications and surgical site infections than those without DM [5,6,8,18,20,21,28]. Hence, achieving optimal glycemic control in patients with DM is important.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, achieving optimal glycemic control in patients with DM is important. However, evidence for which glycemic markers are most predictive of complications is less clear [1,6,7,9,16,21]. We wanted to determine the correlations among the four commonly used glycemic markers and to identify the glycemic markers that were most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with DM after undergoing TKA.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus (DM) is one of the most common and important diseases thought to be associated with an increased risk of perioperative complications among patients undergoing TKA. Previous studies have reported higher rates of infection [8,18,20,21,28], wound complications [5,6], greater risk of deep vein thrombosis [27,29], poorer outcomes [4,13,14,22,25], and higher mortality [2] in patients with DM undergoing TKA compared with patients without DM. Unfortunately, the prevalence of DM among patients undergoing TKA has been steadily increasing [11,15] and orthopaedic surgeons will be faced with a growing number of surgical patients with DM.…”

Section: Introductionmentioning

confidence: 99%

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Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

107

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Background Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. Questions/purposes We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA. Methods Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA 1c ), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA 1c level was 7%, the range was 5% to 11.3%.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Results There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA 1c and PPG2 levels (R = 0.502, p \ 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA 1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

107

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“…SIH is a form of hyperglycemia seen secondary to stress. Trauma of any kind causes a bodily response characterized by enhanced metabolism and hyperglycemia [1,2].…”

Section: Introductionmentioning

confidence: 99%

Non Diabetic and Stress Induced Hyperglycemia [SIH] in Orthopaedic Practice What do we know so Far?

Goyal

Kaur

Sud

et al. 2014

JCDR

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Establishing a recommended duration of blood glucose monitoring in nondiabetic patients following orthopaedic surgery

O’Brien

Hosseinzadeh

Chen

et al. 2021

Journal Orthopaedic Research

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Previous studies have demonstrated that blood glucose (BG) levels should be monitored for at least 1 week after orthopaedic surgery in diabetic patients, but no study has determined how long nondiabetic patients should be monitored. As postoperative elevations in BG have deleterious effects, determining a duration for monitoring the BG of nondiabetic patients after major orthopaedic surgery is needed to detect hyperglycemic events, create comprehensive protocols for nondiabetic orthopaedic patients, and reduce adverse outcomes. A retrospective study was conducted including consecutive patients who underwent a major orthopaedic surgery at a community hospital. A BG level of 150 mg/dl was the cutoff used to define hyperglycemia according to our institutional guidelines. A χ2, analysis of variance, and subgroup analysis were performed separately. Greater than 67% of nondiabetic patients experienced a high BG level (>150 mg/dl) after surgery. We found that nondiabetic patients reached their postoperative maximum BG level at 20 h, which was sooner compared to diabetic patients. We discovered more than 92% of nondiabetic patients reached a maximum BG levels within the first 72 h of hospitalization, while the BG levels after this period were found to be within normal limits in greater than 87% of cases. We propose that BG management be instituted in nondiabetics from the preoperative period to 72 h after surgery, including patients who are same‐day discharges. There may not be a need to continue inpatient BG monitoring beyond the first 72 h for nondiabetic hospitalized patients with extended hospitalizations.

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Perioperative hyperglycaemia and incidence of post-operative complications in patients undergoing total knee arthroplasty

Abstract: Retrospective case series, Level IV.

Cited by 31 publications

References 31 publications

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Non Diabetic and Stress Induced Hyperglycemia [SIH] in Orthopaedic Practice What do we know so Far?

Establishing a recommended duration of blood glucose monitoring in nondiabetic patients following orthopaedic surgery

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