Perioperative Hyperglycemia and Postoperative Infection after Lower Limb Arthroplasty

Mraović, Boris; Suh, Dong Hun; Jacovides, Christina; Parvızı, Javad

doi:10.1177/193229681100500231

Cited by 227 publications

(174 citation statements)

References 26 publications

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“…A previous study found an association between HbA 1c levels C 8 and wound complications but no association with early postoperative deep infection in patients with DM after TKA [6]. On the other hand, our finding of the only association of preoperative FBG C 200 mg/dL with superficial surgical site infection is in contrast with previous studies reporting the association of preoperative FBG level C 126 mg/dL [9], postoperative FBG level C 126 mg/dL [21], and postoperative FBG level C 200 mg/dL [16] with the occurrence of complications after total joint arthroplasty. Our findings, taken together with previous studies, suggest that surgeons should think carefully before performing this elective procedure in a patient with HbA 1C C 8 or FBG C 200 mg.…”

Section: Discussioncontrasting

confidence: 99%

“…Hence, achieving optimal glycemic control in patients with DM is important. However, evidence for which glycemic markers are most predictive of complications is less clear [1,6,7,9,16,21]. We wanted to determine the correlations among the four commonly used glycemic markers and to identify the glycemic markers that were most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with DM after undergoing TKA.…”

Section: Discussionmentioning

confidence: 99%

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Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

109

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Background Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. Questions/purposes We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA. Methods Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA 1c ), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA 1c level was 7%, the range was 5% to 11.3%.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Results There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA 1c and PPG2 levels (R = 0.502, p \ 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA 1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

109

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show abstract

“…Additionally, not only is the preoperative glucose level an important factor, but Mraovic et al demonstrated that the postoperative blood glucose level also plays an important role as far as the risk for PJI is concerned (28). The authors stated that patients with sugar levels of greater than 200 mg/dl on postoperative day one were twice more likely to develop PJI.…”

Section: Medical Optimization Of Hostmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection

Rezapoor

Parvızı

2015

The Journal of Arthroplasty

Self Cite

122

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“…Mraovic et al, reviewed elective primary total hip and knee arthroplasty from 2000 to 2008. They found that Non-DM patients were 3 times more likely to develop the infection if their morning BG was >140 mg/dl on post-operative day and gave their concluding remarks that even patients without a diagnosis of DM who developed postoperative hyperglycemia had a significantly increased risk for the infection [26].…”

Section: Arthroplasty and Non-diabetic Hyperglycemiamentioning

confidence: 99%

Non Diabetic and Stress Induced Hyperglycemia [SIH] in Orthopaedic Practice What do we know so Far?

Goyal

Kaur

Sud

et al. 2014

JCDR

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Perioperative Hyperglycemia and Postoperative Infection after Lower Limb Arthroplasty

Cited by 227 publications

References 26 publications

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Prevention of Periprosthetic Joint Infection

Non Diabetic and Stress Induced Hyperglycemia [SIH] in Orthopaedic Practice What do we know so Far?

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