scholarly journals Elective hip arthroplasty rates and related complications in people with diabetes mellitus

2020 ◽  
pp. 112070002098157
Author(s):  
Lindsey C McVey ◽  
Nicholas Kane ◽  
Helen Murray ◽  
RM Dominic Meek ◽  
S Faisal Ahmed
Keyword(s):  
Diabetes Mellitus ◽  
Postoperative Complications ◽  
Glycaemic Control ◽  
Hip Arthroplasty ◽  
Surgical Complications ◽  
Complication Rates ◽  
Obese Patients ◽  
Poor Glycaemic Control ◽  
Increased Risk ◽  
The Impact

Background and Aims: Diabetes mellitus (DM), poor glycaemic control and raised body mass index (BMI) have been associated with postoperative complications in arthroplasty, although the relative importance of these factors is unclear. We describe the prevalence of DM in elective hip arthroplasty in a UK centre, and evaluate the impact of these factors. Methods: We analysed retrospective data for DM patients undergoing arthroplasty over a 6-year period and compared with non-diabetic matched controls (1 DM patient: 5 controls). DM was present in 5.7% of hip arthroplasty patients (82/1443). Results: Postoperative complications occurred in 12.2% of DM patients versus 12.9% of controls ( p = 1.000); surgical complications were present in 6.1% of those with DM and 2.4% of controls ( p = 0.087), while medical complications occurred in 8.5% of DM patients versus 10.7% of controls ( p = 0.692). Complications developed in 23.1% of DM patients with poor glycaemic control (HbA1c > 53 mmol/mol) versus 9.8% with good control ( p = 0.169). In DM patients and controls combined, complications occurred in 16.3% of obese patients versus 10.0% of non-obese patients ( p = 0.043). In the DM cohort, 13.7% of overweight patients had complications versus 0% with a normal or low BMI ( p = 0.587). Conclusions: DM rates were lower than expected, and glycaemic control was good. Overall complication rates were unrelated to the presence of DM or to glycaemic control, although surgical complications were observed more frequently in those with DM and poor glycaemic control was uncommon within our cohort. Complications were more frequent in those with a higher BMI. Whether some patients with DM but without an increased risk of complications are currently being excluded from surgery requires exploration.

scholarly journals Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 710
Author(s):  
Abel Botelho Quaresma ◽  
Fernanda da Silva Barbosa Baraúna ◽  
Fábio Vieira Teixeira ◽  
Rogério Saad-Hossne ◽  
Paulo Gustavo Kotze
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Randomized Studies ◽  
Pubmed Database ◽  
Increased Risk ◽  
The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

Direct superior approach with standard instrumentation for total hip arthroplasty: safety and efficacy in a prospective 200-case series

2019 ◽  
Vol 30 (5) ◽  
pp. 552-558 ◽  
Author(s):  
Eleftherios Tsiridis ◽  
Eustathios Kenanidis ◽  
Michael Potoupnis ◽  
Fares E Sayegh
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Functional Score ◽  
Complication Rates ◽  
Obese Patients ◽  
Total Hip ◽  
Increased Risk ◽  
Superior Approach ◽  
Standard Instrumentation

Introduction: Direct Superior Approach (DSA) is a muscle sparing approach for total hip arthroplasty (THA) implemented using special instrumentation. There is a lack of information in the literature concerning DSA with standard instrumentation. Materials and methods: 238 patients were recruited for primary THA by a single surgeon from January 2016 until May 2017. 209 patients underwent THA through DSA approach with non-offset acetabular reamers and femoral broaches. We evaluated accuracy of implantation, complications and early functional results. Independent orthopaedic surgeons performed the clinical and radiographic assessments. Results: 200 patients were followed for a year. 3 different implants were used. No sciatic nerve palsies, hip dislocations or fractures were recorded. There was one acute deep and superficial wound infection. The mean functional score was significantly improved at all follow-ups ( p < 0.001). 97% of stems were inserted into the neutral coronal and 96% in neutral sagittal alignment. All cups fell within a safe zone of inclination and 91% of anteversion. 2 hips demonstrated heterotopic ossification, Brooker class I. Obese patients had no increased risk of complications. Conclusions: DSA with standard instrumentation is safe and efficacious for THA. It offers fast recovery and facilitates correct implantation of different implants, can be useful even for hip dysplasia and obese patients with minimal complication rates.

Increased fat depth is not associated with increased risk of surgical complications following total hip arthroplasty

2020 ◽  
Vol 102-B (9) ◽  
pp. 1146-1150
Author(s):  
Alistair I. W. Mayne ◽  
Roslyn S. Cassidy ◽  
Paul Magill ◽  
Owen J. Diamond ◽  
David E. Beverland
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Complications ◽  
Subcutaneous Fat ◽  
Lumbar Spine Surgery ◽  
Consecutive Series ◽  
Complication Rates ◽  
Greater Trochanter ◽  
Total Hip ◽  
Increased Risk

Aims Previous research has demonstrated increased early complication rates following total hip arthroplasty (THA) in obese patients, as defined by body mass index (BMI). Subcutaneous fat depth (FD) has been shown to be an independent risk factor for wound infection in cervical and lumbar spine surgery, as well as after abdominal laparotomy. The aim of this study was to investigate whether increased peritrochanteric FD was associated with an increased risk of complications in the first year following THA. Methods We analyzed prospectively collected data on a consecutive series of 1,220 primary THAs from June 2013 until May 2018. The vertical soft tissue depth from the most prominent part of the greater trochanter to the skin was measured intraoperatively using a sterile ruler and recorded to the nearest millimetre. BMI was calculated at the patient’s preoperative assessment. All surgical complications occuring within the initial 12 months of follow-up were identified. Results Females had a significantly greater FD at the greater trochanter in comparison to males (median 3.0 cm (interquartile range (IQR) 2.3 to 4.0) vs 2.0 cm (IQR 1.7 to 3.0); p < 0.001) despite equivalent BMI between sexes (male median BMI 30.0 kg/m2 (IQR 27.0 to 33.0); female median 29.0 kg/m2 (IQR 25.0 to 33.0)). FD showed a weak correlation with BMI (R² 0.41 males and R² 0.43 females). Patients with the greatest FD (upper quartile) were at no greater risk of complications compared with patients with the lowest FD (lower quartile); 7/311 (2.3%) vs 9/439 (2.1%); p = 0.820 . Conversely, patients with the highest BMI (≥ 40 kg/m2) had a significantly increased risk of complications compared with patients with lower BMI (< 40 kg/m2); 5/60 (8.3% vs 18/1,160 (1.6%), odds ratio (OR) 5.77 (95% confidence interval (CI) 2.1 to 16.1; p = 0.001)). Conclusion We found no relationship between peritrochanteric FD and the risk of surgical complications following primary THA. Cite this article: Bone Joint J 2020;102-B(9):1146–1150.

scholarly journals Heart failure in diabetes: From an increased risk to a treatment target

2018 ◽  
Vol 21 (5) ◽  
pp. 399-403 ◽  
Author(s):  
Eberhard Standl
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Risk ◽  
Glycaemic Control ◽  
Treatment Target ◽  
Poor Glycaemic Control ◽  
Increased Risk

Heart failure (HF) is one of the most common comorbidities of type 2 diabetes mellitus (T2DM) and poor glycaemic control can worsen the HF outcomes and increase the risk of hospitalisations. With the entry of several antihyperglycaemic agents for the management of T2DM over the last decade, there has been an increasing concern regarding the cardiovascular (CV) safety profile of these agents. In view of this, FDA mandated the demonstration of cardiovascular risk-benefit profile of these agents through specifically designed CV outcome trials. Although we have several findings from these trials, none of them included HF as a primary endpoint indicating the need of trials focusing on HF. Here, we briefly discuss the results of the CV outcome trials in the context of HF.

THE IMPACT OF MINIMALLY INVASIVE SPINE SURGERY ON PERIOPERATIVE COMPLICATIONS IN OVERWEIGHT OR OBESE PATIENTS

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 693-699 ◽  
Author(s):  
Paul Park ◽  
Cheerag Upadhyaya ◽  
Hugh J.L. Garton ◽  
Kevin T. Foley
Keyword(s):  
Adverse Events ◽  
Minimally Invasive ◽  
Perioperative Complications ◽  
Complication Rates ◽  
Obese Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Lumbar Spinal ◽  
The Impact

Abstract OBJECTIVE Open lumbar spinal surgery in overweight or obese patients has been associated with increased risk of perioperative complications. The impact of minimally invasive spinal (MIS) surgery on the incidence of perioperative adverse events in overweight or obese patients, however, has not been well evaluated. METHODS A retrospective review of consecutive patients undergoing lumbar MIS surgery from January 2006 to April 2007 was performed. Of the 77 patients identified, 56 had a body mass index (BMI) of 25.0 kg/m2 or greater. RESULTS Of the 56 patients with a BMI of 25 kg/m2 or greater, 32 (57.1%) were men; the mean age was 54.1 years. The mean BMI was 31.0 kg/m2 (range, 25.1–43.8 kg/m2). Using a broad definition of an adverse event, eight (14.3%) complications were identified. In the discectomy/laminotomy subgroup (31 patients), two (6.5%) adverse events were noted. In the fusion subgroup (25 patients), six (24%) adverse events were noted, most of which were minor. Of the 21 patients with a BMI less than 25 kg/m2, eight (38.1%) were men, and the mean age was 43.7 years. The mean BMI was 22.5 kg/m2 (range, 16.8–24.6 kg/m2). Three (14.3%) complications were noted overall. In the discectomy/laminotomy subgroup (17 patients), two (11.8%) adverse events occurred. One (25%) complication developed in the four patients making up the fusion subgroup. There was no statistically significant difference in complication rates between groups. Logistic regression also found no statistically significant relationship between BMI and perioperative complications. CONCLUSION There does not appear to be an increased risk of developing perioperative complications in overweight or obese patients undergoing MIS surgery, which may reflect a potential benefit of the MIS approach.

scholarly journals Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

2021 ◽  
Vol 10 (15) ◽  
pp. 3375
Author(s):  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
Toshitaka Yoshii ◽  
Satoru Egawa ◽  
Takashi Hirai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cervical Spine ◽  
Postoperative Complications ◽  
Spine Surgery ◽  
Posterior Longitudinal Ligament ◽  
Lower Extremity Function ◽  
Cervical Spine Surgery ◽  
The Impact

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

scholarly journals Gestational Diabetes Mellitus and Infant Adiposity at Birth: A Systematic Review and Meta-Analysis of Therapeutic Interventions

2021 ◽  
Vol 10 (4) ◽  
pp. 835
Author(s):  
Manoja P. Herath ◽  
Jeffrey M. Beckett ◽  
Andrew P. Hills ◽  
Nuala M. Byrne ◽  
Kiran D. K. Ahuja
Keyword(s):  
Diabetes Mellitus ◽  
Adipose Tissue ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fat Mass ◽  
Metabolic Disorders ◽  
Later Life ◽  
Therapeutic Interventions ◽  
Increased Risk ◽  
The Impact

Exposure to untreated gestational diabetes mellitus (GDM) in utero increases the risk of obesity and type 2 diabetes in adulthood, and increased adiposity in GDM-exposed infants is suggested as a plausible mediator of this increased risk of later-life metabolic disorders. Evidence is equivocal regarding the impact of good glycaemic control in GDM mothers on infant adiposity at birth. We systematically reviewed studies reporting fat mass (FM), percent fat mass (%FM) and skinfold thicknesses (SFT) at birth in infants of mothers with GDM controlled with therapeutic interventions (IGDMtr). While treating GDM lowered FM in newborns compared to no treatment, there was no difference in FM and SFT according to the type of treatment (insulin, metformin, glyburide). IGDMtr had higher overall adiposity (mean difference, 95% confidence interval) measured with FM (68.46 g, 29.91 to 107.01) and %FM (1.98%, 0.54 to 3.42) but similar subcutaneous adiposity measured with SFT, compared to infants exposed to normal glucose tolerance (INGT). This suggests that IGDMtr may be characterised by excess fat accrual in internal adipose tissue. Given that intra-abdominal adiposity is a major risk factor for metabolic disorders, future studies should distinguish adipose tissue distribution of IGDMtr and INGT.

scholarly journals The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

2021 ◽  
Author(s):  
M. Runkel ◽  
T. D. Diallo ◽  
S. A. Lang ◽  
F. Bamberg ◽  
M. Benndorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Visceral Obesity ◽  
The Body ◽  
Postoperative Outcomes ◽  
Sarcopenic Obesity ◽  
Colorectal Metastases ◽  
Complication Rates ◽  
The Impact ◽  
Body Compositions

Abstract Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

scholarly journals When can total knee arthroplasty be safely performed following prior arthroscopy?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jin-Ning Ma ◽  
Xiao-Lin Li ◽  
Pan Liang ◽  
Sheng-Li Yu
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Acl Injury ◽  
Control Group ◽  
Optimal Timing ◽  
Complication Rates ◽  
Increased Risk ◽  
Total Knee

Abstract Background The optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA. Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA. Results The all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p < 0.05). The survivorship of the KA group and control group was 92.0 and 99.4% at the 2-year follow-up (p = 0.002), respectively. Male (Hazards ratio [HR] = 3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR = 4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months. Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

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