Low Post-Op Glucose Levels Tied to Infection Risk

The study, “Postoperative Blood Glucose Levels Predict Infection After Total Joint Arthroplasty,” was published in the August 15, 2018 edition of The Journal of Bone and Joint Surgery.

Antonia Chen, M.D., M.B.A., with the Department of Orthopaedic Surgery, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts, and co-author explained to OTW, “Much attention has been focused on preoperative optimization of arthroplasty patients prior to surgery, including reduction of hemoglobin A1C and glucose levels in diabetic patients. Little attention has been paid to glucose levels in the postoperative period, especially in non-diabetic patients.”

“Glucose levels can increase in the postoperative period due to stress and irregular glycemic control. Thus, we were interested in studying the topic of postoperative glucose levels to see if they correlated to periprosthetic joint infection in diabetic and non-diabetic patients.”

The study investigators conducted a retrospective review of 24,857 primary total joint arthroplasties performed from 2001 to 2015. The investigators found that 13,196 of the arthroplasties had a minimum follow-up of 1 year (mean, 5.9 years). They then looked at postoperative day 1 morning blood glucose levels and correlated those measures with periprosthetic joint infection, as defined by the International Consensus Group on Periprosthetic Joint Infection.

According to Dr. Chen, “The most important result was that a postoperative glucose level greater than 137mg/dL correlated to an increased risk of periprosthetic joint infection in total joint arthroplasty patients.”

“The most practical recommendation is to monitor postoperative glucose levels in our arthroplasty patients after surgery. While the traditional recommendation is to keep glucose under 200mg/dL, it may be time to consider lower postoperative blood glucose levels to decrease the risk of infection after surgery.”

“Additionally, we need to closely monitor patients who are both diabetic and non-diabetic, as non-diabetic patients can have elevated glucose levels. It may be beneficial to place our patients on low carbohydrate diets postoperatively to regulate glucose levels.”

“We want orthopedic surgeons to recognize that it is important to optimize our total joint arthroplasty patients before and after surgery. Glucose will rise in the postoperative period, and it is important to monitor and regulate these values to decrease dreaded complications such as periprosthetic joint infections. We can help prevent these periprosthetic joint infections by evaluating diabetic and non-diabetic patients, and potentially keeping patients on consistent carbohydrate diets during the postoperative period.”