High preoperative blood sugar may increase risk of periprosthetic joint infection after THA

Hyperglycemia, high blood sugar or high blood glucose, has been identified as a risk factor for periprosthetic joint infection after THA. However, there is no consensus about the preoperative blood glucose level on the day of the surgical procedure linked with increased risk. Therefore, Julian Wier, University of Southern California Keck School of Medicine, Los Angeles, California, and colleagues aimed to identify preoperative BGL thresholds associated with an increased risk of PJI.

For this purpose, the Premier Healthcare Database was retrospectively assessed for adult patients who underwent primary, elective total hip arthroplasty and had a measurement of the preoperative BGL recorded on the day of the surgical procedure (preoperative BGL) from 2016 to 2021.

The association between preoperative BGL and 90-day risk of periprosthetic joint infection was modelled using multivariable logistic regression with restricted cubic splines. Patients with and without diabetes with a preoperative BGL associated with 1.5 times greater odds of PJI (high preoperative BGL) were compared with patients with a normal preoperative BGL.

The study led to the following findings:

· 90,830 patients who underwent THA and had a recorded preoperative BGL were identified.

· The preoperative BGL associated with 1.5 times greater odds of PJI was 277 mg/dL in patients with diabetes and 193 mg/dL in patients without diabetes.

· Compared with the normal preoperative BGL cohort, those with high preoperative BGL had increased odds of PJI (adjusted odds ratio [OR], 2.60 for patients with diabetes and 1.66 for patients without diabetes) and 90-day readmissions (adjusted OR, 1.92 for patients with diabetes and 1.66 for patients without diabetes).

"The findings showed that an increased preoperative BGL was associated with an increased PJI risk following primary THA," the researchers wrote.

"Surgeons should be aware of patients with diabetes and a preoperative BGL of >277 mg/dL and patients without diabetes but with a preoperative BGL of >193 mg/dL," they concluded.

Reference:

Wier, Julian MD1; Liu, Kevin C. BS1; Richardson, Mary K. BS1; Gettleman, Brandon S. BS2; Kistler, Natalie M. BS1; Heckmann, Nathanael D. MD1,a; Lieberman, Jay R. MD1. Higher Blood Glucose Levels on the Day of Surgery Are Associated with an Increased Risk of Periprosthetic Joint Infection After Total Hip Arthroplasty. The Journal of Bone and Joint Surgery ():10.2106/JBJS.23.00546, December 21, 2023. | DOI: 10.2106/JBJS.23.00546