Saturday, May 11, 2013

Diabetes control and wound complications after total joint surgery

Elevated Postoperative Blood Glucose and Preoperative Hemoglobin A1C Are Associated with Increased Wound Complications Following Total Joint Arthroplasty

From among 1702 patients having total joint replacements, those with wound complications within thirty days after the index arthroplasty were identified. A control group matched for exact age, sex, procedure, tourniquet use, surgical approach, and use of antibiotic cement was also created.

Patients with a mean postoperative glucose of >200 mg/dL had an odds ratio for developing a wound complication of 3.75. 
Patients with a maximum postoperative blood glucose of >260 mg/d had an odds ratio for developing a wound complication of 3.0
Patients with a preoperative hemoglobin A1C value of >6.7% had an odds ratio for developing a wound complication of 9.0.

The authors point that this study did not show that good glycemic control resulted in reduced risk. They did demonstrate that poor preoperative and postoperative glucose control is independently associated with wound complications.

These results are in contrast to those of
Surgical outcomes of total knee replacement according to diabetes status and glycemic control, 2001 to 2009, a study of Kaiser enrollees.
The authors found that of 40,491 patients who underwent total knee arthroplasty, 7567 (18.7%) had diabetes, 464 (1.1%) underwent revision arthroplasty, and 287 (0.7%) developed a deep infection. Compared with the patients without diabetes, no association between controlled diabetes (HbA1c < 7%) and the risk of revision (odds ratio [OR], 1.32; 95% confidence interval [CI], 0.99 to 1.76), risk of deep infection (OR, 1.31; 95% CI, 0.92 to 1.86), or risk of deep venous thrombosis or pulmonary embolism (OR, 0.84; 95% CI, 0.60 to 1.17) was observed. Similarly, compared with patients without diabetes, no association between uncontrolled diabetes (HbA1c ≥ 7%) and the risk of revision (OR, 1.03; 95% CI, 0.68 to 1.54), risk of deep infection (OR, 0.55; 95% CI 0.29 to 1.06), or risk of deep venous thrombosis or pulmonary embolism (OR, 0.70; 95% CI, 0.43 to 1.13) was observed.
The authors concluded that no significantly increased risk of revision arthroplasty, deep infection, or deep venous thrombosis was found in patients with diabetes (as defined on the basis of preoperative HbA1c levels and other criteria) compared with patients without diabetes in the study population of patients who underwent elective total knee arthroplasty.



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