Risk factors for perioperative hyperglycemia in primary hip and knee replacements

Abstract

Background and purpose — Perioperative hyperglycemia has been associated with adverse outcomes in several fields of surgery. In this observational study, we identified factors associated with an increased risk of hyperglycemia following hip and knee replacement.

Patients and methods — We prospectively monitored changes in glucose following primary hip and knee replacements in 191 patients with osteoarthritis. Possible associations of patient characteristics and operation-related factors with hyperglycemia (defined as glucose > 7.8 mmol/L in 2 consecutive measurements) and severe hyperglycemia (glucose > 10 mmol/L) were analyzed using binary logistic regression with adjustment for age, sex, operated joint, and anesthesiological risk score.

Results — 76 patients (40%) developed hyperglycemia, and 48 of them (25% of the whole cohort) had severe hyperglycemia. Glycemic responses were similar following hip replacement and knee replacement. Previously diagnosed diabetes was associated with an increased risk of hyperglycemia and severe hyperglycemia, compared to patients with normal glucose metabolism, whereas newly diagnosed diabetes and milder glucose metabolism disorders had no effect. In patients without previously diagnosed diabetes, increased values of preoperative glycosylated hemoglobin (HbA1c) and fasting glucose on the day of operation were associated with hyperglycemia. Higher anesthesiological risk score—but none of the operation-related factors analyzed—was associated with an increased risk of hyperglycemia.

Interpretation — Perioperative hyperglycemia is common in primary hip and knee replacements. Previously diagnosed diabetes is the strongest risk factor for hyperglycemia. In patients with no history of diabetes, preoperative HbA1c and fasting glucose on the day of operation can be used to stratify the risk of hyperglycemia.

EJ, PIN, JK, and TM designed the study. EJ and JK participated in collecting the materials. EJ performed statistical analysis, wrote the first draft of the manuscript, and took care of revisions. All the authors contributed to interpretation of the results and preparation of the manuscript.

We acknowledge financial support for this study from the Competitive Research Funding of Tampere University Hospital, Tampere, Finland (grants 9M026 and 9N020) (representing governmental funding) and from the Emil Aaltonen Foundation, Tampere, Finland.

AE has received lecture fees from DePuy and Stryker and congress payments from DePuy (all unrelated to the present work). TM has received lecture fees from Roche and MSD and congress payments from DePuy (all unrelated to the present work). The other authors have nothing to disclose.