Preadmission Hyperglycemia is an Independent Risk Factor for In-Hospital Symptomatic Pulmonary Embolism After Major Orthopedic Surgery
Section snippets
Materials and Methods
After obtaining institutional board review approval, we reviewed the medical records of patients undergoing total hip or total knee arthroplasty from January 1, 2001, to April 30, 2006. Data were collected from electronic medical records and included comorbidities recorded during the patients' preoperative clinic visits.
Results
Data from 11 283 patients who had hip or knee arthroplasty in the study period were reviewed. After excluding the patient records (total of 3347) with missing data (height and/or weight [3342 records], preoperative blood glucose values [912 records], American Society of Anesthesiologists [ASA] status and preoperative comorbidities [3330 records]), 7936 patient records were eligible for the study. In addition, the data from repeated admissions were excluded (654 records). After all exclusions, a
Discussion
Our retrospective study showed that in patients receiving warfarin for thromboprophylaxis preadmission BG of at least 200 mg/dL increases risk of in-hospital symptomatic pulmonary embolism after total hip and knee arthroplasty. A single, random preadmission BG of at least 200 mg/dL had the risk for in-hospital symptomatic PE of similar magnitude as the other recognized risk factors, such as BMI, age, knee surgery, and bilateral surgery, independently increasing the risk more than 3 times.
The
Acknowledgment
Contributing authors are as follows: Inna Chervoneva, PhD, data analysis and review of the manuscript; Zvi Grunwald, MD, review of the manuscript; and Luis Pulido, MD, data collection and review of the manuscript.
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2021, Journal of ArthroplastyCitation Excerpt :Significant predictors of VTE included history of diabetes, use of general anesthesia, and lower ASA score. Four previous studies have investigated diabetes in TJA and found no association with VTE [24–27]; however, preadmission hyperglycemia has been associated with PE after major orthopedic surgery [27]. Previous studies have demonstrated a greater risk of VTE with TKA compared to THA, possibly due to quicker mobility postoperatively; however, our analysis found that there was no significant difference in VTE rates between TKA and THA [27–29].
Immediate preoperative hyperglycemia correlates with complications in non-cardiac surgical cases
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This research was conducted with the support from the Investigator-Initiated Study Program of LifeScan Inc, 1000 Gibraltar Dr, MS 3I, Milpitas, CA 94040.
Presented in part at CAS Annual Meeting, Calgary, Alberta, Canada, June 2007 and ASA annual meeting, San Francisco, CA, October 2007.