Perioperative hyperglycaemia in elective arthroplasties. Should we do better?

Area of Science:

• Endocrinology
• Orthopedic Surgery
• Perioperative Medicine

Background:

• Perioperative hyperglycemia is linked to adverse outcomes.
• Existing glucose management guidelines show poor adherence in clinical practice.
• Elective hip and knee arthroplasty patients require optimized glucose control.

Purpose of the Study:

• To evaluate glucose management in diabetic and non-diabetic patients undergoing elective hip or knee arthroplasty.
• To assess adherence to glucose management guidelines in this patient population.
• To identify undetected hyperglycemia and at-risk patients.

Main Methods:

• Prospective measurement of capillary plasma glucose (CPG) four times daily in 209 patients.
• Analysis of clinical team actions in response to CPG values.
• Evaluation of patient risk detection using FINDRISC scores.

Main Results:

• Hyperglycemia (≥7.8 mmol/l) was prevalent, affecting over 80% of patients, with severe hyperglycemia (>10 mmol/l) in 40%.
• Diabetic patients, both on and off insulin, frequently experienced hyperglycemia.
• No hyperglycemic episodes >10 mmol/l were treated, and at-risk patients were often unnoticed.

Conclusions:

• Hyperglycemia is highly prevalent in elective orthopedic surgery patients, irrespective of diabetes status.
• Current perioperative glucose management is inadequate, with significant guideline non-adherence.
• Enhanced education and specialist support are crucial for improving perioperative glucose control.