Postoperative Hyperglycemia Can Be Safely and Effectively Controlled in Both Diabetic and Nondiabetic Patients with Use of a Subcutaneous Insulin Protocol

JB & JS Open Access
John M GallagherKaitlyn K Beam

Abstract

Postoperative hyperglycemia related to stress has been shown to be an independent risk factor for periprosthetic joint infection. In a non-intensive care, general-surgery setting, a standardized postoperative insulin protocol has been shown to decrease the rate of wound infections. We hypothesized that the use of a similar protocol is both safe and effective for controlling hyperglycemia in patients who have undergone total joint replacement. We performed a retrospective cohort study of 489 consecutive patients who underwent primary or revision total hip or knee arthroplasty between January 2008 and April 2013. All patients were tested with point-of-care (finger-stick) glucose determinations postoperatively and were started on a subcutaneous insulin protocol if they had postoperative stress hyperglycemia of >140 mg/dL when fasting or >180 mg/dL after meals. Insulin was discontinued when blood glucose decreased to <100 mg/dL. Of the 489 patients, 301 (62%) qualified for the insulin protocol. Thirty-seven (17%) of the 220 patients for whom the hemoglobin A1c level was available were diabetic, and 21 (11%) of the 187 patients for whom body mass index data were available were morbidly obese (body mass index, ≥40 kg/m2). Diabetes (p...Continue Reading

References

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Citations

Jul 6, 2018·The Journal of Bone and Joint Surgery. American Volume·Noam ShohatJavad Parvizi
Aug 15, 2018·The Journal of Bone and Joint Surgery. American Volume·Michael M KheirAntonia F Chen
Nov 26, 2020·Anesthesia and Analgesia·Milla OrtvedUNKNOWN Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group
Oct 22, 2021·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Todd M O'BrienHany S Bedair
Dec 4, 2021·Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders·Raffaella Di LuzioGiampaolo Bianchi

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