Published: Mar. 5, 2008
Updated: Mar. 5, 2008
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By Duke Medicine News and Communications
Durham, NC – People with diabetes who undergo knee or hip replacements are more likely to experience serious complications resulting in longer hospital stays and higher costs, according to researchers at Duke University Medical Center.
In one of the most comprehensive studies conducted to date, higher rates of joint replacement complications were found among those with either type 1 or type 2 diabetes than in people without diabetes.
"These findings are of concern because they illustrate that surgery-related complications cause patients to spend more time in the hospital, use more resources, and experience a slower recovery period," said Dr. Michael P. Bolognesi, the lead investigator of the study, who presented the findings at the Annual Meeting of the American Academy of Orthopaedic Surgeons. "This is the first data demonstrating the influence of diabetes types 1 and 2 in hip and knee replacement patients."
Half of the 20 million Americans living with diabetes are over age 60. The mid- to late-sixties are also when the majority of hip and knee replacements occur – often due to arthritis – which is a common condition among those with diabetes.
The study included 65,769 patients who had been included in a national database of hospital patients called the National Inpatient Sample. Data was pulled from patient reports among those identified as diabetic who underwent joint replacement surgery between 1988 and 2003.
The researchers found that type 1, or insulin-dependent, diabetes patients experienced more complications than those with type 2 diabetes. The complications observed included heart attack, pneumonia, urinary tract infection, post-surgery bleeding, wound infection, and even death. When the data was broken down into subgroups based on diabetes type and level of disease control, patients with uncontrolled type 2 diabetes experienced more complications than any other group.
Type 2 diabetes, the most common form of the disease, can often be managed through diet and exercise. Uncontrolled diabetes can lead to a range of serious health complications, such as heart disease, stroke and kidney disease.
"Exercise is an important component of a diabetes management plan, so it is critical that patients are able to get back on their feet as quickly as possible following surgery," said Bolognesi. "These findings illustrate that surgeons need to have their radar up and make sure that patients have their diabetes controlled before and during surgery. In some cases, alternatives to surgery may be considered until glucose levels are within a normal range to reduce the risk for complications."
As our population continues to age, it is expected that the number of people who have diabetes will rise, as will the number of people who undergo hip or knee replacements.
"Continued research is needed to identify mechanisms to help patients experience fewer complications following surgery," Bolognesi said. "In the meantime, doctors need to closely communicate with their patients and encourage good blood sugar control. Patients with controlled diabetes had fewer complications and risks."
Co-authors on the study include Milford H. Marchant, Jr., Nicholas A. Viens, Chad Cook, Ricardo Pietrobon and Thomas Parker Vail.