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Best Abstracts - Runner-up Session 2

Postoperative morbidity in diabetics after fast-track primary total hip and knee arthroplasty

ESAAP2-2

Jørgensen, C. C.; Madsbad, S.; Kehlet, H. The Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty Collaboration

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 5-5
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Background and Goal of Study: Diabetes is a risk factor for postoperative mortality and morbidity in many types of surgery, including major joint arthroplasty1, with thresholds for perioperative blood glucoses being debatable2. No previous studies have been done in a standardized fast-track setting with optimized perioperative care including spinal anesthesia, opioid sparing multimodal analgesia and early mobilization, which has improved outcome after surgery3. We did a prospective study on the influence of diabetes on length of hospital stay (LOS), 90-days readmissions and mortality after primary elective total hip (THA) and knee arthroplasty (TKA) with a standardized fast-track setup.

Materials and Methods: A prospective multicenter study in consecutive unselected patients with detailed information on LOS, readmissions and mortality through patients medical files, and 100% follow-up using the Danish National Health register. Information on antidiabetic treatment was found using The Danish National Database of Reimbursed Prescriptions. Multiple logistic regression analysis on LOS and readmissions was used to adjust for demographics and comorbidity.

Results and Discussion: In 5168 patients 20 (0.4%) had type 1 diabetes (T1D), 566 (11.0%) had type 2 diabetes (T2D) and 4582 (88.7%) were nondiabetics. Of diabetics, 9% used insulin only, 12% had combination treatment, 60% used oral antidiabetica only and 19% received diet treatment.

Median LOS was 2 days (interquartile range 1) and 30 and 90 days readmission rate and mortality was 6.2%, 8.4% and 0.33% respectively. There was no increase in LOS >5days (OR:0.90 95%CI:0.60-1.37; p=0.413) 30 (1.16:0.80-1.69; 0.427) and 90 days readmissions (1.25:0.91-1.71; 0.169) or “diabetes related” readmissions (infections etc) (1.25:0.73-2.14; 0.407) with T2D. This did not change when stratifying according to medical treatment. No specific analysis was made on T1D due to low numbers.

Our results are in contrast to prior studies without a fast-track setup1 and are likely due to decreased surgical stress when using the fast-track approach3, thereby reducing the influence of diabetes.

Conclusion(s): Diabetes per se does not seem to impair outcome with regard to LOS, readmissions and morbidity after fast-track THA/TKA

References:

1. Iorio, J Arthroplasty 2012
2. Webster, Br J Anaesth 2009
3. Kehlet, Langenbecks Arch.Surg. 2011

Acknowledgements: We thank Professor Lars Pedersen at The Danish National Database of Reimbursed Prescriptions.

© 2013 European Society of Anaesthesiology