Preadmission Hyperglycemia is an Independent Risk Factor for In-Hospital Symptomatic Pulmonary Embolism After Major Orthopedic Surgery

Mraović, Boris; Hipszer, Brian; Epstein, Richard H.; Pequignot, Edward; Parvızı, Javad; Joseph, Jeffery

doi:10.1016/j.arth.2008.10.002

Cited by 80 publications

(81 citation statements)

References 23 publications

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“…Older age, female gender, obesity, underlying disease, type of anesthesia, simultaneous bilateral THAs, surgical approach, and prolonged immobilization in bed are known risk factors for DVT and PE in studies of patients from Western countries [2,19,21,30]. After multivariate analysis in this study, prolonged immobilization was identified as a risk factor for DVT.…”

Section: Discussionmentioning

confidence: 86%

Deep Venous Thrombosis and Pulmonary Embolism are Uncommon in East Asian Patients after Total Hip Arthroplasty

Kang

Lee

Kim

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background In Western countries, deep vein thrombosis (DVT) and pulmonary embolism (PE), are relatively common after THA and many surgeons recommend routine pharmacologic thromboprophylaxis. There is some suggestion in the literature that the incidences of DVT and PE may be lower in East Asian patients. Therefore, it would be important to establish the incidences in a large number of East Asian patients who did not receive pharmacologic thromboprophylaxis.Purpose We therefore determined the incidence of DVT and PE and evaluated the associated risk factors in a series of East Asian patients who underwent primary THA without pharmacologic prophylaxis. Methods We retrospectively evaluated all 861 patients who underwent 992 elective primary THAs from May 2003 to December 2009. We identified patients with symptomatic DVT, symptomatic PE, and fatal PE. For potential risk factors we considered age, gender, body mass index (BMI), administration of aspirin, type of anesthesia, operation time, approach, simultaneous bilateral THAs, and duration of immobilization between symptomatic and asymptomatic patients. Results We identified eight patients with symptomatic DVT, one of whom also had a symptomatic PE; there were no cases of fatal PE. The incidences of fatal PE, symptomatic PE, and symptomatic DVT were 0 %, 0

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Section: Discussionmentioning

confidence: 86%

Deep Venous Thrombosis and Pulmonary Embolism are Uncommon in East Asian Patients after Total Hip Arthroplasty

Kang

Lee

Kim

et al. 2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Another study in Canada showed a direct relationship between glucose concentration and the risk of pulmonary embolism, with up to a fourfold increased risk in patients undergoing total joint replacement with preoperative levels [ 200 mgÁdL -1 (11.1 mmoLÁL -1 ). 2 In cardiac surgery patients, preoperative glucose concentrations [ 110 mgÁdL -1 (6.1 mmoLÁL -1 ) have been associated with a longer hospital stay and increased mortality. 3 The findings of this study confirm the notion that aspects of our preoperative assessment of surgical patients should be re-examined.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 In addition, the American Heart Association has identified hyperglycemia as an independent risk factor for cardiovascular disease in both men and women. 4 Detrimental outcomes are not exclusive to diabetics.…”

mentioning

confidence: 99%

The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study

Abdelmalak

Knittel

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Given that preoperative hyperglycemia is associated with poor outcomes and many non-diabetic patients have high plasma glucose (PG) levels, the purpose of our study was to estimate the prevalence of undiagnosed diabetes among non-cardiac surgery patients and to identify predictors of hyperglycemia in non-diabetics. MethodsWe included all non-cardiac surgery patients with complete records in the Clinical Database of the Anesthesiology Institute at the Cleveland Clinic during January 2007 to April 2009, and we estimated the prevalence of undiagnosed diabetes and impaired fasting glucose (IFG) among the non-diabetic patients. The mean glucose levels for known diabetics and undiagnosed diabetics were compared using two-tailed Student's t tests, and we assessed the association between PG levels and demographic variables within the non-diabetics. Results Of the 39,434 patients analyzed, 5,511 (14%) were known diabetics. Of the 33,923 known non-diabetics, 3,426 (10 %) were undiagnosed diabetics and another 3,549 (11%) had IFG. Thus, 6,975 patients (21%) of the non-diabetic patients presented with abnormally high glucose. Previously undiagnosed diabetics had higher preoperative glucose levels compared with known diabetics, with a mean ± standard deviation (SD) of 161 ± 48 vs 146 ± 67 mgÁdL -1 (8.9 ± 2.7 vs 8.1 ± 3.7 mmoLÁL -1 ), respectively. The difference remained highly significant after adjusting for body mass index, age, sex, and American Society of Anesthesiologists (ASA) physical status (P \ 0.001). Among non-diabetics, older age, obesity, male sex, and a higher ASA physical status were collectively significant predictors of hyperglycemia, with a c-statistic (95% confidence interval) of 0.67 (0.66-0.68). Conclusion A significant proportion of non-cardiac surgery patients have previously undiagnosed diabetes and pre-diabetes. Previously undiagnosed patients have higher fasting glucose levels compared with diabetic patients. Further studies should be conducted to identify the implications of these findings on patient outcomes. RésuméObjectif E´tant donne´que l'hyperglyce´mie pre´ope´ratoire est associe´e à un mauvais pronostic et que de nombreux Preliminary results were presented at

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“…The effect of diabetes on surgical outcomes has been shown in several studies (2,(24)(25)(26). Higher rates of postoperative complications in patients with diabetes lead to increased resource utilization by this population and higher health-care costs.…”

Section: Discussionmentioning

confidence: 99%

Preoperative A1C and Clinical Outcomes in Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

et al. 2014

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OBJECTIVETo evaluate the relationship between preoperative A1C and clinical outcomes in individuals with diabetes mellitus undergoing noncardiac surgery. RESEARCH DESIGN AND METHODSData were obtained from the National Surgical Quality Improvement Program database and the Research Patient Data Registry of the Brigham and Women's Hospital. Patients admitted to the hospital for ‡1 day after undergoing noncardiac surgery from 2005 to 2010 were included in the study. RESULTSOf 1,775 patients with diabetes, 622 patients (35%) had an A1C value available within 3 months before surgery. After excluding same-day surgeries, patients with diabetes were divided into four groups (A1C £6.5% [N = 109]; >6.5-8% [N = 202]; >8-10% [N = 91]; >10% [N = 47]) and compared with age-, sex-, and BMI-matched nondiabetic control subjects (N = 888). Individuals with A1C values between 6.5 and 8% had a hospital length of stay (LOS) similar to the matched control group (P = 0.5). However, in individuals with A1C values £6.5 or >8%, the hospital LOS was significantly longer compared with the control group (P < 0.05). Multivariate regression analysis demonstrated that a higher A1C value was associated with increased hospital LOS after adjustments for age, sex, BMI, race, type of surgery, Charlson Comordity Index, smoking status, and glucose level on the day of surgery (P = 0.02). There were too few events to meaningfully evaluate for death, infections, or readmission rate. CONCLUSIONSOur study suggests that chronic hyperglycemia (A1C >8%) is associated with poor surgical outcomes (longer hospital LOS). Providing a preoperative intervention to improve glycemic control in individuals with A1C values >8% may improve surgical outcomes, but prospective studies are needed.

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Preadmission Hyperglycemia is an Independent Risk Factor for In-Hospital Symptomatic Pulmonary Embolism After Major Orthopedic Surgery

Cited by 80 publications

References 23 publications

Deep Venous Thrombosis and Pulmonary Embolism are Uncommon in East Asian Patients after Total Hip Arthroplasty

Deep Venous Thrombosis and Pulmonary Embolism are Uncommon in East Asian Patients after Total Hip Arthroplasty

The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study

Preoperative A1C and Clinical Outcomes in Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

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