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Good Glucose Control Important for Joint Replacement Patients

Diabetic patients with poor control of blood glucose face an increased risk of post-surgical complications and death following total hip or knee arthroplasty, according to a new study.

Dr. Milford H. Marchant, Jr., Duke University Medical Center, Durham, North Carolina noted that, “The results confirm our hypothesis that, regardless of type, patients with uncontrolled diabetes demonstrate significantly more perioperative complications as compared with patients with controlled diabetes or patients without diabetes.”
 
The investigators retrospectively analyzed the impact of glycemic control on various outcomes after total joint arthroplasty. Study subjects included 920,555 non-diabetic patients, 105,485 patients with controlled diabetes, and 3,973 patients with uncontrolled diabetes who underwent total hip or knee replacement between 1988 and 2005.
 
They found that, compared with patients with controlled diabetes, patients with uncontrolled diabetes had a significantly higher odds of stroke (adjusted OR, 3.42), urinary tract infection (adjusted OR, 1.97), ileus (adjusted OR, 2.47), wound infection (adjusted OR, 2.28), postoperative hemorrhage (adjusted OR, 1.97), transfusion (adjusted OR, 1.19), and death (adjusted OR, 3.23).
 
Dr. Marchant noted in a statement that, “It did not matter if the patient had Type 1 or Type 2 diabetes.… Regardless of diabetes type, we found that patients had fewer complications after surgery if their glucose level was controlled before, during and after surgery.”
 
Patients without diabetes incurred significantly lower hospital charges than those with diabetes, and patients with controlled diabetes had significantly shorter hospital stays than patients with uncontrolled diabetes.
 
“It is crucial that patients have glucose levels well-managed before, during and after surgery, because it reduces the potential of having a complication,” Dr. Marchant said. “This is the responsibility of both the patient and the surgeon and it should be a priority.”
 
J Bone Joint Surg Am July,2009;91:1621-1629.