Inadequate glycemic testing prior to joint replacement surgery
medwireNews: A substantial proportion of patients undergoing total joint replacement (TJR) do not receive a test for glycemic control prior to surgery, researchers report.
This is despite diabetes being “a frequent comorbidity” among people with osteoarthritis – the most common indication for TJR in the USA – and the known relationship between suboptimal glucose control and poor outcomes after arthroplasty, explain Lindsey MacFarlane (Brigham and Women's Hospital, Boston, Massachusetts, USA) and colleagues.
The team used the Medicare database to evaluate rates of hyperglycemia testing among 465,566 patients who underwent total hip or knee replacement between 2018 and 2019, 28% of whom had diabetes.
As reported in a research letter in JAMA Network Open, just 4.9% of the 335,365 patients without diabetes had a glycated hemoglobin test in the 90 days before surgery. Among individuals with diabetes, testing rates were 25.8% for the 49,965 not receiving medication, 39.0% for the 59,705 taking noninsulin medications, and 43.4% for the 20,531 receiving insulin. The corresponding rates of serum glucose testing were 37.2%, 45.7%, 47.7%, and 50.2%.
These findings suggest “[f]urther study on the utility of perioperative hyperglycemia monitoring and optimization is warranted,” concludes the team.
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