For better joint surgery outcome, control diabetes

Diabetic patients with uncontrolled diabetes face an increased risk of surgical complications and death following hip or knee replacements, according to a study in The Journal of Bone and Joint Surgery.

Keeping blood sugar - glucose - levels in check is the hallmark of good control of diabetes. Dr. Milford H. Marchant Jr. from Duke University Medical Center, Durham, North Carolina, and colleagues studied 920,555 non-diabetic patients, 105,485 patients with controlled diabetes, and 3973 patients with uncontrolled diabetes who underwent total hip or knee replacement between 1988 and 2005.

They found that, compared with patients with controlled diabetes, after surgery, patients with uncontrolled diabetes had more than three times the risk of a stroke or death, and about twice the risk of wound infections and bleeding. There were 39 deaths (about 1 percent) in the uncontrolled diabetes group, 248 deaths (about a quarter of a percent) in the controlled diabetes group, and 2506 deaths (also about a quarter of a percent) in the no diabetes group.

The findings suggest that the 8 percent of patients undergoing joint replacement in the U.S. every year who have diabetes could benefit from better diabetes control. The researchers not that the risks were higher regardless of whether patients had type 1 diabetes, in which patients require insulin to control their blood glucose, or type 2, which does not require insulin.

"We found that patients had fewer complications after surgery if their glucose level was controlled before, during and after surgery," Marchant said in a statement.

Patients without diabetes incurred significantly lower hospital charges than those with diabetes, and patients with controlled diabetes had significantly shorter hospital stays than patients with uncontrolled diabetes.

"It is crucial that patients have glucose levels well-managed before, during and after surgery, because it reduces the potential of having a complication," Dr. Marchant said. "This is the responsibility of both the patient and the surgeon and it should be a priority."

SOURCE: The Journal of Bone and Joint Surgery, July 2009.