Elevated Postoperative Blood Glucose and Preoperative Hemoglobin A1C Are Associated with Increased Wound Complications Following Total Joint Arthroplasty

Abstract Background: Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia.Methods: Patients undergoing primary total hip or knee arthroplasty were randomized to Group A (8 mg ondansetron), Group B (10 mg dexamethasone plus mosapride), or Group C (three doses of 10 mg dexamethasone plus mosapride). The primary outcome was the incidence of PONV. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications.Results: Patients in Group C experienced a lower incidence of severe PONV (1.72%, p<0.001) and a higher incidence of complete response (70.69%, p=0.001) than did patients in Groups A and B. Moreover, less rescue antiemetic treatment and postoperative opioid consumption was needed in Group C (p<0.05). Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups.Conclusion: Prophylactic use of mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.

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

10.21203/rs.3.rs-16693/v1 ◽

2020 ◽

Author(s):

Yongyu Ye ◽

Baiqi Pan ◽

Guoyan Xian ◽

Weishen Chen ◽

Ziji Zhang ◽

...

Keyword(s):

Blood Glucose ◽

Total Joint Arthroplasty ◽

Medical Records ◽

Glucose Variability ◽

Joint Arthroplasty ◽

Optimal Time ◽

Primary Group ◽

Optimal Timing ◽

Diabetic Patients ◽

Glucose Levels

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.

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