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

Abstract

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.