Dexamethasone Is Associated With a Statistically Significant Increase in Postoperative Blood Glucose Levels Following Primary Total Knee Arthroplasty

Volkmar, Alexander J.; Schultz, Jacob; Rickert, Mariel M; Polkowski, Gregory G.; Engstrom, Stephen M.; Martin, John R.

doi:10.1016/j.artd.2022.101076

Cited by 7 publications

(1 citation statement)

References 27 publications

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“…Glycemic control in patients with diabetes is an important perioperative variable for surgeons to consider. Poor perioperative glycemic control has been associated with higher risk of complications postoperatively 88,89 . Given that GLP-1 agonists provide a substantial benefit in improving glycemic control by lowering preoperative, perioperative, and postoperative blood glucose concentrations and insulin requirements, their use in patients undergoing surgery is appealing [90][91][92][93] .…”

Section: Considerations For the Orthopaedic Surgeonmentioning

confidence: 99%

Glucagon-like Peptide-1 Agonists

Chan,

Mika,

Martin

et al. 2024

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» Orthopaedic surgeons are increasingly likely to encounter patients with obesity and/or type 2 diabetes taking glucagon-like peptide-1 (GLP-1) agonists for weight loss.» GLP-1 agonists are an effective treatment for weight loss with semaglutide and tirzepatide being the most effective agents. Randomized controlled trials using these agents have reported weight loss up to 21 kg (46 lb).» The use of GLP-1 agonists preoperatively can improve glycemic control, which can potentially reduce the risk of postoperative complications. However, multiple cases of intraoperative aspiration/regurgitation have been reported, potentially related to the effect of GLP-1 agonists on gastric emptying.» While efficacious, GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight. Multifactorial approaches to weight loss with focus on lifestyle modification in addition to GLP-1 agonists should be considered in such patients.» Although GLP-1 agonists are efficacious agents for weight loss, they may not be accessible or affordable for all patients. Each patient's unique circumstances should be considered when creating an ideal weight loss plan during optimization efforts.

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