Abstract
Dysglycemia in the post-operative period has been associated with increased rates of infection following total joint arthroplasty. Additionally, patients without clinical diagnosis of diabetes with hemoglobin A1c% values between 5.7% and 6.4% have been shown to be dysglycemic in the peri-operative period. This study examines the influence of post-operative blood glucose management on rates of re-operation for infection in patients undergoing total joint arthroplasty in diabetic, and clinically non-diabetic patients.
We performed a retrospective review of prospectively collected data, for all primary, elective total hip and total knee arthroplasties performed at The Ottawa Hospital between April 2010 and October 2017. Kaplan-Meier survivorship, and mutivarient regression analysis were used to determine predictors of infection based on pre-operative diabetes status, HbA1c%, and post-operative insulin management.
4159 joints met inclusion criteria. Patients with HbA1c 5.7–6.4% had lower rate of revision for infection if they received post-operative blood glucose management (0.80%), vs without glucose management (1.20%). Kaplan-Meier survivorship analysis showed this difference to be insignificant (p=0.23). Patients with DM1 had statistically worse survivorship when compared to other groups (p=0.010).
Patients with undiagnosed perioperative dysglycemia may be at a greater predisposition for developing infection, requiring re-operation, following total joint arthroplasty. This study may be underpowered due to overall low rates of revision. More rigorous peri-operative glucose management strategies may be required for patients, who otherwise receive no glycemic management outside of hospital. This is more pertinent with trends towards decreasing post-operative lengths-of-stay.
