Type-2 diabetes was not associated with a LOS >4 days or 30- or 90-day readmissions. (Image Source: Thinkstock)

Type-2 diabetes was not associated with a LOS >4 days or 30- or 90-day readmissions. (Image Source: Thinkstock)

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The incidence of diabetes mellitus, particularly type-2, is increasing rapidly. Diabetes is a risk factor for morbidity in many types of major surgery. For joint arthroplasty the data are inconclusive, with recent studies failing to show an association between diabetes and postoperative morbidity. However, there have been no studies examining the outcome of diabetic patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a standardized fast-track setting with optimized perioperative care.

Dr. Christoffer C. Jørgensen, Section for Surgical Pathophysiology, Copenhagen University, Copenhagen, Denmark, and The Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement, Copenhagen, Denmark, and colleagues from the Section of Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen, Denmark, the Department of Endocrinology, Hvidovre University Hospital, Copenhagen, Denmark, and members of the Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement collaborative group, compared the outcomes of 890 type-2 diabetic patients and 7165 nondiabetic patients undergoing primary arthroplasty. Their results are discussed in the article titled “Postoperative Morbidity and Mortality in Type-2 Diabetics After Fast-Track Primary Total Hip and Knee Arthroplasty,” which is published in this month’s issue of Anesthesia and Analgesia.

The investigators collected results from 7 centers between February 2010 through November 2012 and used propensity matching to compare diabetic and nondiabetic patients. They found that type-2 diabetes was not associated with a length of hospital stay (LOS) >4 days or readmissions after 30 and 90 days. Diabetes-related morbidity was increased significantly in insulin-treated type-2 diabetic patients.

These results show that there is no increase in surgical morbidity in type-2 diabetics undergoing primary arthroplasty with a fast-track protocol. The use of insulin in type-2 diabetes, particularly basal insulins, is increasing (20% of patients in this study), and this was associated with increased “medical” morbidity. The benefits of a fast-track protocol are well recognized and good perioperative glucose control may also have been important.

This is a seminal study: it sets the standard of care to be achieved in diabetic patients undergoing arthroplasty.