Inadequate Glycemic Control Is Associated With Increased Surgical Site Infection in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

Shohat, Noam; Muhsen, Khitam; Gilat, Ron; Rondon, Alexander J.; Chen, Antonia F.; Parvızı, Javad

doi:10.1016/j.arth.2018.02.020

Cited by 82 publications

(55 citation statements)

References 36 publications

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“…The clear association between postoperative glucose levels and postoperative complications has been supported by many studies, in which some of the former studies considered diagnosis of DM as a critical risk factor for postoperative complications including PJI, SSI, and aseptic implant loosening [1,3,[15][16][17]. Hyperglycemia, which is independent from DM, was considered to be a risk factor for perioperative complications of surgical procedures including PJI by previous studies [2], is receiving more attention in the clinic [1,5,9,10,18].…”

Section: Discussionmentioning

confidence: 99%

“…Effective management of hyperglycemia can help to improve surgical outcomes in patients with TJA [21]. Several studies suggested that feasible glycemic control is beneficial to reduce postoperative mortality, length of stay, and complications [22][23][24]. Additionally, glycemic control is considered to be a critical procedure to decrease the risk of adverse outcomes after surgery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Optimal Time for Blood Glucose Measurements in Patients Who Underwent Primary or Revision Total Joint Arthroplasty: A Retrospective Review

Ye¹,

Pan²,

Xian³

et al. 2020

Preprint

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Background Perioperative hyperglycemia is a risk factor for postoperative complications after total joint arthroplasty (TJA). However, the most optimal timing to detect blood glucose and the extent of elevation of postoperative glucose remain unknown. Our study investigated differences in perioperative blood glucose fluctuations between primary and revision groups to determine optimal timing for glycemic control. Methods We retrospectively evaluated medical records of 1,788 TJA patients from October 2013 to November 2018. We examined blood glucose values collected within 6 days perioperatively. Each time point’s findings were evaluated with descriptive statistics. Glucose variability was assessed by coefficient of variation (CV). Differences in glucose levels were compared between primary and revision groups. Results The final cohort included medical records of 1,480 patients (1,417 primary, 63 revision). Mean glucose values were highest on postoperative day 1 (117±35 and 132±50 mg/dL) in primary and revision groups, respectively ( P <0.001). Postoperative day 1 included the highest number of hyperglycemic patients (glucose >100 mg/dL) with 66.4% and 75.5% in primary and revision groups, respectively. The CV of primary and revision group nondiabetic and diabetic patients was 6.85% and 9.02% and 12.83% and 15.31%, respectively. Conclusions Postoperative day 1 was the most sensitive time for glucose control. Hyperglycemia occurred on postoperative day 1 in most patients who underwent TJA in both groups. Primary group diabetics and revision group had higher postoperative glycemic fluctuations than primary group nondiabetics. Our results reveal the need for specialized protocols for clinicians to detect and monitor hyperglycemia in patients under different situations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Optimal Time for Blood Glucose Measurements in Patients Who Underwent Primary or Revision Total Joint Arthroplasty: A Retrospective Review

Ye¹,

Pan²,

Xian³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Numerous studies have shown that poor preoperative glycaemic control is associated with increased complication rates in the perioperative period. These include increased length of stay, [4] an increased risk of failure of total ankle replacements, [5] increased infection rates in hip and knee arthroplasty, [6] and an increased risk of poor postoperative glycaemic control and postoperative complications. [7] In 2015, Kallio et al [19] demonstrated that referral of poorly controlled diabetic patients (HbA1c >10%) to primary healthcare services for optimisation of glycaemic control before proceeding with total joint arthroplasty resulted in lower complication rates and shorter hospital stays.…”

Section: Discussionmentioning

confidence: 99%

A multicentre prospective observational study of the prevalence and glycaemic control of diabetes mellitus in adult non-cardiac elective surgical patients in hospitals in Western Cape Province, South Africa

et al. 2019

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Diabetes mellitus (DM) is a common condition, affecting an estimated 15.5 million people in Africa. Importantly, the prevalence of DM across the continent is expected to double by 2045. [1] Since 2015, this condition has been ranked as the second most common cause of natural death in South Africa (SA), and its impact on healthcare provision is substantial. [2] Accurate assessment of prevalence is difficult owing to the high burden of undiagnosed DM (estimated at 69% in Africa) and the lack of large population studies. [1] In SA, the prevalence of DM is estimated to be between 5.4% and 9.2%. [1,3] There are limited data reporting the prevalence of DM in Western Cape Province, SA, and information with regard to elective surgical patients is minimal. Many studies have shown that DM, especially if poorly controlled, is associated with an increased risk of perioperative complications and mortality. [4-9] In SA, insulin-dependent surgical patients are twice as likely as non-diabetics to die in hospital. [10] Objectives The primary objective of this study was to establish the prevalence of DM in patients presenting for elective surgery over a 1-week period in six Western Cape hospitals. This included patients with a previous diagnosis of DM, and those with a new diagnosis based on screening capillary blood glucose (CBG) testing and a confirmatory elevated glycated haemoglobin (HbA1c) level. The secondary objectives were to assess: (i) the glycaemic control of known diabetics presenting for This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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“…A similar rationing of care is taking place regarding risk factors such as perioperative glucose control and tobacco use (Table 1). Preoperatively predicting perioperative glucose control remains challenging, however, and the validity of using hemoglobin A1c, which measures a collective 90‐days of serum glucose control, as a surrogate measure has recently been questioned 32–34 . Alternative tests such as perioperative serum glucose levels and fructosamine have been described as more sensitive measures of perioperative glucose control, and have demonstrated promise in preoperative screening for high‐risk patients 35,36 .…”

Section: New Advancements In Prevention Of Pjimentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

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Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity. Advancements in our knowledge of this condition have focused on prevention, diagnosis, and treatment, in order to reduce rates of PJI and improve patient outcomes. Preventive measures such as optimization of patient comorbidities, and perioperative antibiotic usage are intensive areas of current clinical research to reduce the rate of PJI. Improved diagnostic tests such as synovial fluid (SF) α‐defensin enzyme‐linked immunosorbent assay, and nucleic acid‐based tests for serum, SF, and tissue cultures, have improved diagnostic accuracy and organism identification. Increasing the diversity of available antibiotic therapy, immunotherapy, and alternative implant coatings remain promising treatments to improve infection eradication in the setting of PJI.

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Inadequate Glycemic Control Is Associated With Increased Surgical Site Infection in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

Cited by 82 publications

References 36 publications

The Optimal Time for Blood Glucose Measurements in Patients Who Underwent Primary or Revision Total Joint Arthroplasty: A Retrospective Review

The Optimal Time for Blood Glucose Measurements in Patients Who Underwent Primary or Revision Total Joint Arthroplasty: A Retrospective Review

A multicentre prospective observational study of the prevalence and glycaemic control of diabetes mellitus in adult non-cardiac elective surgical patients in hospitals in Western Cape Province, South Africa

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

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