Preoperative Glycemic Control Predicts Perioperative Serum Glucose Levels in Patients Undergoing Total Joint Arthroplasty

Godshaw, Brian; Ojard, Connor; Adams, Tyler; Chimento, George; Mohammed, Asmaa N.; Waddell, Bradford S.

doi:10.1016/j.arth.2018.02.071

Cited by 29 publications

(25 citation statements)

References 28 publications

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“…Godshaw et al [21] found that higher blood glucose levels and higher PJI rates were related not to dexamethasone use but instead to a diagnosis of diabetes. They also found that elevated HbA1c is significantly related to postoperative hyperglycemia [21,22]. Although our findings are supportive of prior investigations regarding the effect of dexamethasone on perioperative glucose control, we present useful new data and perspective on what is a practical clinical question as to whether all diabetic patients should receive perioperative dexamethasone.…”

Section: Discussionsupporting

confidence: 86%

The Effect of Dexamethasone on Postoperative Blood Glucose in Patients With Type 2 Diabetes Mellitus Undergoing Total Joint Arthroplasty

Allen

Jedrzynski

Michelson

et al. 2020

The Journal of Arthroplasty

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Section: Discussionsupporting

confidence: 86%

The Effect of Dexamethasone on Postoperative Blood Glucose in Patients With Type 2 Diabetes Mellitus Undergoing Total Joint Arthroplasty

Allen

Jedrzynski

Michelson

et al. 2020

The Journal of Arthroplasty

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“…This, however, does not correlate with previous studies demonstrating that peri-operative hyperglycemia is a risk factor for PJI [27]. Godshaw et al's [34] study investigated the relationship between pre-operative glycemic control and post-operative hyperglycemia and reported that higher pre-operative A1c values lead to increased rate of post-operative hyperglycemia >200 mg/dL; however, no significant increase in the rate of PJI was found. For this, preoperative A1c cutoffs have been proposed to lower the risk of PJI, ranging from 7% to 8% [28,31,35,36].…”

Section: Discussionmentioning

confidence: 73%

The Effects of Peri-Operative Dexamethasone on Patients Undergoing Total Hip or Knee Arthroplasty: Is It Safe for Diabetics?

Godshaw

Mehl

Shaffer

et al. 2019

The Journal of Arthroplasty

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Background: Peri-operative dexamethasone has been shown to effectively reduce post-operative nausea and vomiting and aide in analgesia after total joint arthroplasty (TJA); however, systemic glucocorticoid therapy has many adverse effects. The purpose of this study is to determine the effects of dexamethasone on prosthetic joint infection (PJI) and blood glucose levels in patients undergoing TJA. Methods: A retrospective chart review of all patients receiving primary TJA from 2011 to 2015 (n ¼ 2317) was conducted. Patients were divided into 2 cohorts: dexamethasone (n ¼ 1426) and no dexamethasone (n ¼ 891); these groups were subdivided into diabetic and non-diabetic patients. The primary outcome was PJI; secondary measures included glucose levels and pre-operative hemoglobin A1c (A1c) values. Statistics were carried out using logistic and regression models. Results: Of the 2317 joints, 1.12% developed PJI; this was not affected by dexamethasone (P ¼ .166). Diabetics were found to have higher rate of infection (P < .001); however, diabetics who received dexamethasone were not found to have a significantly higher infection rate that non-diabetics (P ¼ .646). Blood glucose levels were found to increase post-operatively, and dexamethasone did not increase this change (P ¼ .537). Diabetes (P < .001) and increasing hemoglobin A1c (P < .001) were also associated with increased serum glucose levels; however, this was not influenced by dexamethasone (P ¼ .595). Conclusion: Although diabetic patients were found to have a higher infection rate overall, this was not affected by administration of intravenous dexamethasone, nor was the post-operative elevation in serum glucose levels. In this study population, peri-operative intravenous dexamethasone did not increase the rate of PJI and was safe to administer in patients undergoing TJA.

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“…Mraovic et al (2011) demonstrated that postoperative hyperglycemia greater than 200 mg/dL in patients with diabetes undergoing TJA was at more than 2 times the risk of PJI than those with better glycemic control. Godshaw et al (2018) found that patients undergoing a TJA experienced the most rapid change in complications when A1c was between 6.5% and 7.5% and, therefore, found that the magnitude of the preoperative A1c decrease was more important than achieving an arbitrary cutoff. Furthermore, Harris et al (2013) concluded that preoperative glycemic optimization was more effective with a greater magnitude of A1c reduction than to achieve a specific cutoff.…”

Section: Introductionmentioning

confidence: 95%

“…Diabetes is an independent risk factor for PJI (Godshaw, 2018). Mraovic et al (2011) demonstrated that postoperative hyperglycemia greater than 200 mg/dL in patients with diabetes undergoing TJA was at more than 2 times the risk of PJI than those with better glycemic control.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the effects of a total joint education class on patient outcomes

Marshall¹

2020

Journal of Orthopaedics

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Preoperative Glycemic Control Predicts Perioperative Serum Glucose Levels in Patients Undergoing Total Joint Arthroplasty

Cited by 29 publications

References 28 publications

The Effect of Dexamethasone on Postoperative Blood Glucose in Patients With Type 2 Diabetes Mellitus Undergoing Total Joint Arthroplasty

The Effect of Dexamethasone on Postoperative Blood Glucose in Patients With Type 2 Diabetes Mellitus Undergoing Total Joint Arthroplasty

The Effects of Peri-Operative Dexamethasone on Patients Undergoing Total Hip or Knee Arthroplasty: Is It Safe for Diabetics?

Evaluating the effects of a total joint education class on patient outcomes

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