Glycaemic dysregulation in nondiabetic patients after major lower limb prosthetic surgery

Blood glucose (BG) dysregulation is common after cardiac surgery, but remains poorly described after major noncardiac surgery. The aim of this prospective observational study was to analyze perioperative changes in BG levels in nondiabetic patients undergoing major arthroplasty.

Nondiabetic consenting patients scheduled for hip or knee arthroplasty were eligible. BG levels were assessed from the preoperative period to the end of postoperative day 2. Oral feeding was resumed from the evening after surgery. Hyperglycaemia, defined as two sequential BG measurements that were either greater than 7.0 mmol/L during the fasting period or greater than 11.1 mmol/L 2 hours after a meal, was the primary outcome variable. Two groups of patients were identified, depending on the occurrence or not of hyperglycaemia (hyperglycaemic and normoglycaemic groups, respectively). Patients were followed-up for surgical wound infection for one year postoperatively.

Thirty-eight patients, aged 65+/-14 years (mean+/-S.D.), were included. A significant increase in BG was observed during the fasting period (Anova, P<0.001), and 74% of patients met the primary outcome variable. In the hyperglycaemic group, the mean number of BG measurements per patient above the thresholds was 5.6+/-2.8, and 58% of the patients still had a postmeal BG level greater than 11.1 mmol/L at the end of the study period. No surgical wound infection was observed at follow-up.

This study showed that nearly 75% of nondiabetic patients experience a moderate, but significant, increase in either fasting or postprandial BG levels in the first two days following major arthroplasty.