Abstract
BackgroundPerioperative hyperglycemia is a risk factor for postoperative complications after total joint arthroplasty (TJA). However, the variability of fasting blood glucose (FBG) after TJA remains unknown. We aimed to assess the fluctuation and extent of elevation of FBG following primary or revision TJA.MethodsWe retrospectively evaluated the medical records of 1788 patients who underwent primary or revision TJA between 2013 and 2018. We examined FBG values collected during 6 days of the perioperative period. The findings for each time point were evaluated with descriptive statistics. Postoperative glycemic variability was assessed by the coefficient of variation (CV).ResultsThe final cohort included the medical records of 1480 patients (1417 primary and 63 revision). FBG was highest on postoperative day 1 in the primary and revision groups (P < 0.001), which had the highest number of hyperglycemic patients (FBG > 100 mg/dL), with 66.4% and 75.5% in the primary and revision groups, respectively. The CV of diabetics in the primary group, and diabetics and non-diabetics in the revision group, was higher than that of non-diabetics in the primary group.ConclusionPostoperative day 1 showed the highest FBG levels and proportion of patients with hyperglycemia in the perioperative period. Primary group diabetics, and revision group diabetics and non-diabetics, had higher postoperative fluctuation of FBG than primary group non-diabetics. Frequent FBG monitoring may therefore be warranted in diabetic patients undergoing TJA, and all patients undergoing revision TJA.
Highlights
Perioperative hyperglycemia is a risk factor for postoperative complications after total joint arthroplasty (TJA)
There were no significant differences in fasting blood glucose (FBG) between Postoperative day (POD) 2 and 3, PODs 3 and 4, PODs 4 and 5, or PODs 5 and 6
Further examination of the primary group revealed that FBG at POD1 in diabetics was only significantly higher than that measured preoperatively (P < 0.001), and the variability of FBG was higher in diabetics within the primary group (CV%, 9.02) (Table 2, Fig. 1)
Summary
Perioperative hyperglycemia is a risk factor for postoperative complications after total joint arthroplasty (TJA). The variability of fasting blood glucose (FBG) after TJA remains unknown. Kheir et al noted a linear relationship between postoperative blood glucose and periprosthetic joint infection (PJI) [4], while Shohat et al demonstrated that higher postoperative glucose variability was associated with increased rates of complications [6]. Varady et al suggested that 9 pm on the night of TJA surgery was the most sensitive time within 24 h for detecting hyperglycemia in both diabetic and nondiabetic patients [14]. Though some researchers have demonstrated the variability of glucose levels in patients undergoing TJA and acute fluctuation of blood glucose within 24 h following TJA, an exact conclusion regarding fasting blood glucose (FBG) fluctuation and the extent to which FBG may become elevated postoperatively in TJA patients remains unknown
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