Hip surgery sequentially induces stress hyperglycaemia and activates coagulation

Area of Science:

• Orthopaedic Surgery
• Coagulation Science
• Metabolic Studies

Background:

• Venous thromboembolism (VTE) is a common complication following orthopaedic procedures.
• Hyperglycaemia (high blood glucose) is known to activate the coagulation system.
• Elevated glucose levels are associated with increased postoperative morbidity and mortality.

Purpose of the Study:

• To investigate if glucose levels rise during orthopaedic surgery.
• To determine if increased glucose levels correlate with coagulation system activation.
• To explore the potential role of glucose in VTE development after hip replacement.

Main Methods:

• Nine adult patients undergoing elective hip replacement were studied.
• Venous blood samples were collected preoperatively, intraoperatively, and postoperatively.
• Plasma glucose, factor VIII clotting activity (fVIII:c), von Willebrand factor activity and antigen, and prothrombin fragment 1+2 were measured.

Main Results:

• Plasma glucose levels increased post-anaesthesia, peaking on postoperative day two (8.0 mmol/l) and returning to baseline after seven weeks.
• All measured coagulation parameters showed an increase during surgery, following the rise in glucose levels.
• The changes in fVIII:c and von Willebrand ristocetin cofactor activity significantly correlated with glucose levels.

Conclusions:

• Total hip replacement surgery leads to a significant increase in glucose levels.
• This glucose elevation precedes and is proportionally related to the rise in measured coagulation parameters.
• The findings suggest a potential role for glucose in the activation of the coagulation system during hip surgery, possibly contributing to VTE risk.