Management of Hyperglycemia and Diabetes in Orthopedic Surgery

Akiboye, Funke; Rayman, Gerry

doi:10.1007/s11892-017-0839-6

Cited by 88 publications

(63 citation statements)

References 76 publications

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“…Tailored glucose-controlling, insulin-administrating programs are needed to keep infection and non-infection complications to a minimum. 26 Only a few well-designed controlled studies are available in the orthopedic setting, 27 and the implementation of effective procedures in frail hyperglycemic patients by dedicated teams requires special attention. 28…”

Section: Discussionmentioning

confidence: 99%

<p>Stress Hyperglycemia and Complications Following Traumatic Injuries in Individuals With/Without Diabetes: The Case of Orthopedic Surgery</p>

Luzio¹,

Dusi²,

Mazzotti³

et al. 2020

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Purpose: Hyperglycemia in trauma patients may stem from metabolic response to stress, both in the presence and the absence of underlying diabetes. We aimed to test the association of stress hyperglycemia with risks of adverse events subjects undergoing orthopedic surgery. Patients and Methods: In a prospective observational study, we enrolled 202 consecutive patients with hyperglycemia at hospital admission for trauma injuries requiring orthopedic surgery. Based on history, diabetes was present in 183, and 13 more were defined as unknown diabetes on the basis of HbA1c ≥48mmol/mol. Stress hyperglycemia was defined in subjects with/without diabetes by a stress hyperglycemia ratio (SHR) >1.14, calculated as admission glucose/average glucose, estimated from glycosylated hemoglobin. Logistic regression analysis was used to calculate the risk of post-surgery adverse events associated with different states of hyperglycemia, after correction for demographic and clinical confounders. Results: Stress hyperglycemia was diagnosed, either as superimposed to diabetes (54/196 cases, 27.6%) as well as in the 6 cases without diabetes. At least one complication was recorded in 68 cases (33.7%), the most common being systemic infection (22.8% of cases). In the total cohort, stress hyperglycemia, irrespective of the presence of diabetes, increased the risk of adverse events (any events, odds ratio [OR], 4.43; 95% confidence interval [CI], 2.11-9.30), cardiovascular events (OR, 7.09; 95% CI, 2.47-19.91), systemic infections (OR, 4.21; 95% CI, 1.97-9.03) and other adverse events (OR, 6.30; 95% CI, 1.41-28.03), after adjustment for confounders; hospital stay was much longer. The same was true when the analysis was limited to the diabetes cohort or by comparing pure stress hyperglycemia vs diabetes without stress hyperglycemia. Conclusion: The study highlights the importance of stress hyperglycemia for adverse events in the setting of orthopedic surgery following trauma injuries. This condition requires stricter management, considering the much longer length of hospital stay and higher costs.

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Section: Discussionmentioning

confidence: 99%

<p>Stress Hyperglycemia and Complications Following Traumatic Injuries in Individuals With/Without Diabetes: The Case of Orthopedic Surgery</p>

Luzio¹,

Dusi²,

Mazzotti³

et al. 2020

DMSO

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“…29,30 Diabetes is increasing in prevalence among the elderly population and carries with it a known complication profile, rendering it an important preoperative risk factor for orthopaedic surgeons. 29,31,32 Continued study of the influences on tendon healing after primary open repair is required to understand the interplay of vascular supply and healing metabolites with pain and function postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Extensor Mechanism Ruptures and Reruptures: Perioperative Opioid Management

et al. 2020

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AbstractThe purpose of this study was to determine (1) the correlation between preoperative and postoperative opioid use and (2) risk factors associated with rerupture in patients undergoing open extensor mechanism repair. A retrospective review of patients who underwent operative repair of quadriceps or patellar tendon rupture was performed. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before surgery, or as acute users or chronic users if they received at least one opioid prescription within 1 month or 3 months preceding surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery as well as rerupture rates. A total of 144 quadriceps tendon and 15 patellar tendon repairs were performed at a mean age of 56.8 ± 15.1 years and body mass index of 33.2 ± 7.1. The overall rerupture rate was 6%. Diabetes was a significant risk factor for rerupture (56 vs. 19%, p = 0.023). Chronic preoperative opioid users were more likely to continue to use opioids beyond 1 month postoperatively (p < 0.001) as compared with acute or nonopioid users. Chronic preoperative opioid users (relative risk [RR]: 3.53, 95% confidence interval [CI]: 2.11–5.90) and patients with longer anesthesia time (RR: 1.39, 95% CI: 1.00–1.93) required more monthly opioid refills, whereas tourniquet use required fewer opioid refills each month (RR: 0.57, 95% CI: 0.37–0.88). Compared with patients without a rerupture, each additional prescription refill after the initial repair in the rerupture group was associated with a 22% higher risk of tendon rerupture (RR: 1.22, 95% CI: 1.07–1.39). The chronicity of preoperative opioid intake was found to have a significant effect on postoperative opioid use. This study suggests that there is a higher prevalence of rerupture in patients with prolonged opioid use postoperatively and among diabetics.

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“…Patients with diabetes are often 'optimized' pre-operatively, starting in primary care, which includes attaining good glycaemic control, sufficiently managing other diabetes-related co-morbidities and ensuring careful planning of care at all stages of the patient pathway [41,42]. Given that a patient's baseline QoL is likely to be strongly correlated with their subsequent QoL over the follow-up period [43], there is scope to leverage the use of PROMs to optimize patients' well-being pre-operatively to improve post-surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%