Perioperative Management of Diabetes and Hyperglycemia in Patients Undergoing Orthopaedic Surgery

Medical Comorbidities Are Independent Preoperative Risk Factors for Surgical Infection After Total Joint Arthroplasty

“…Not only do we establish independent infection risk for multiple patient-specific factors, but we provide adjusted estimates of effect size that will allow clinicians to more readily interpret infection risk in patients with multiple medical conditions. For example, it has been difficult to discern the independent effect of frequently comorbid conditions such as diabetes and obesity on infection risk [7,30]. We establish that after adjusting for obesity, conditions such as obesity hypoventilation syndrome are nonsignificant risk factors, whereas diabetes mellitus is independently associated with SSI but with a smaller effect size than suggested by unadjusted estimates.…”

“…Patients with a BMI greater than 50 kg/m 2 reportedly have an 18.3 times higher odds of infection compared with BMI lower than 50 kg/m 2 [21]. Diabetes mellitus is also associated with SSI in patients undergoing arthroplasty [12,13], although the degree of attributable risk for infection independent of obesity is difficult to establish [6,30]. These risks may increase morbidity and mortality while also adding the burden of increased cost [15,18].…”

Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery

“…The author commented that the small size of the population precluded any definitive conclusions about the matter but further consideration of the issue was necessary. At present, there is a paucity of literature on hyperglycemia in nondiabetic patients following orthopaedic surgery 1 . We therefore performed the present study to evaluate the relationship of hyperglycemia with thirty-day surgical-site infection in a population of orthopaedic trauma patients without a history of diabetes at the time of admission.…”

“…As quality health-care measures focus on outcomes-related events, there is presently little discussion about blood glucose monitoring in orthopaedic patients who present without a history of diabetes mellitus 1,28 . While management of blood glucose levels may reach beyond the scope of the general orthopaedic surgeon, this study suggests that recognition of the relationship between hyperglycemia and infectious complications may substantially influence postoperative care of orthopaedic patients.…”

“…T he relationship between hyperglycemia and adverse orthopaedic surgical outcomes, such as infectious complications, has been described 1 . Many of these investigations have focused on patients with a history of diabetes mellitus.…”