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Diabetes and Obesity Negatively Effect Joint Replacement Outcomes

Those with diabetes are ore likely to suffer post-operative complications.Flexible Using a database of nearly 1 million Americans who underwent major joint replacement surgery, a team led by researchers at Duke University Medical Center have determined those surgical patients with diabetes, hypertension or obesity were significantly more likely to suffer post-operative complications.

The team recommended that physicians and researchers evaluate treating such at-risk patients before surgery to control blood sugar, reduce blood pressure and prevent dangerous clot formation, to reduce the likelihood of complications.

These findings have broad implications for the health care delivery system, the researchers said, since more than 700,000 major joint replacement surgeries are performed annually in the U.S. at a cost exceeding $10 billion. Furthermore, as the incidence of diabetes, hypertension and obesity increases and the population ages, orthopedic surgeons must expect to see not only more, but sicker, patients and they will need to know how to effectively treat them, said the researchers.

"Hypertension, diabetes and obesity are important independent predictors of increased complications for patients undergoing major joint replacement surgery," said the study’s first author Nitin Jain, M.D.

Specifically, in their analysis of patients undergoing hip, knee or shoulder replacement surgery, the researchers found that 3.7 percent of obese patients experienced in-hospital complications, compared to 2.6 percent for non-obese patients. For patients with hypertension, the rates were 2.8 percent versus 2.6 percent, and for patients with diabetes, the ranges were 2.9 percent versus 2.6 percent.

Furthermore, the likelihood of a "non-routine" discharge from the hospital was 30 percent higher for diabetics and 45 percent higher in obese patients — for patients with diabetes who were also obese, the likelihood rose to 75 percent. Non-routine discharges are those to another facility where further care is necessary, such as short-term hospitals, intermediate care facilities or home health care.

While further studies are needed to find strategies to reduce complication rates, the researchers said that strategies such as better control of blood glucose levels and blood pressure during surgery need to be evaluated as possible ways to improve the outcomes for patients with diabetes and high blood pressure. They also recommend that the use of blood-thinning drugs post-operatively to prevent the formation of deep vein thrombosis (DVT), in which clots that can form deep in muscles during extended periods of inactivity can break loose to cause heart attacks or stroke, be evaluated.

the journal Clinical Orthopedics and Related Research, June 2005

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