Diabetes and Hip or Knee Replacement

The prevalence of patients with diabetes undergoing surgery ranges between 8% and 20%. People with diabetes are internationally considered “high-risk” patients in the context of surgery. Previous research has established a link between uncontrolled diabetes and hyperglycemia with an increased risk of postoperative complications and longer hospitalization periods after surgery, including Knee and Hip arthroplasty.

However, patients who undergo primary Knee and Hip arthroplasty in a standardized fast-track regimen have fewer complications and reduced hospitalization times, with median stay decreasing to one day without any increase in readmissions. The benefits of a standardized fast-track approach are well-documented and result in faster rehabilitation and less impact on glucose homeostasis which may give patients with diabetes a reduced risk of complications.

A recent prospective study found that patients with diabetes undergoing Knee and Hip arthroplasty in a fast-track regimen had increased odds of longer hospital stays while patients with insulin-treated diabetes also had a slightly increased risk of complications compared to non-insulin-treated diabetic patients and those without diabetes. Importantly the study found no increased risk of postoperative infections or readmission rate but highlighted the need for further research concerning postoperative complications differentiated by type of antihyperglycemic treatment.

The optimal management of perioperative blood glucose and administration of antidiabetic drugs is widely debated and lacks high-grade evidence. Numerous studies have suggested the benefits of glycemic control during the perioperative period, but inconsistent definitions of diabetes mellitus and research in disparate surgical settings in the existing literature makes it difficult to analyze data across studies. This is reflected in the complicated and heterogeneous national and international guidelines calling for the development of systematic strategies to achieve optimal glycemic control to reduce complications, and enhanced recovery after surgery for people with diabetes.

The surgical treatment is homogeneous in this standardized fast-track regimen, which gives us a unique opportunity to investigate diabetes treatment with few confounders.

In this collaboration, we aim to investigate the difference between length of stay after surgery, 90-day readmission rate and complication rate for diabetic patients compared to non-diabetic patients. For the first time, we have the opportunity to examine the relationship between preoperative HbA1c and adverse outcomes in a high-risk patient group undergoing a standardized regimen. We will also describe how antihyperglycemic treatment is managed before and during hospitalization and stratifying all outcomes based on type of antihyperglycemic medication. Furthermore, we wish to investigate the 90-day readmission rate and complication rate between outpatients with diabetes and inpatients with diabetes.

The overall goal is to optimize the perioperative course for surgical patients with diabetes and, hopefully to contribute to a better understanding of perioperative diabetes treatment and safety.

Madsbad, S., M. Wiberg, L. M. Issa, S. Schmidt, and H. Kehlet. “[Not Available].” Ugeskr Laeger 184, no. 42 (Oct 17 2022). Challenges for perioperative glycaemic control in patients with diabetes. https://www.ncbi.nlm.nih.gov/pubmed/36305254.

Ortved, Milla, Pelle B. Petersen, Christoffer C. Jørgensen, Henrik Kehlet, on behalf of the Lundbeck Foundation Centre for Fast-track Hip Group, and Collaborative Knee Replacement. “Postoperative Morbidity and Mortality in Diabetic Patients after Fast-Track Hip and Knee Arthroplasty: A Prospective Follow-up Cohort of 36,762 Procedures.” Anesthesia & Analgesia 133, no. 1 (2021/07// 2021): 115-22. Accessed 2022/03/19/23:23:27. https://dx.doi.org/10.1213/ANE.0000000000005248.