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High preoperative blood glucose increases pulmonary emboli risk after THR, TKR

Hyperglycemic patients had a pulmonary embolism rate 6.2 times higher than control group patients.

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Patients who receive total hip or knee replacements and have high blood glucose levels before surgery have a significantly higher risk for postoperative pulmonary embolism, a study found.

"These data suggest that if an individual has high blood glucose and is coming for surgery, he or she should correct it first and probably postpone the surgery," Boris Mraovic, MD, an assistant professor of anesthesiology at the Jefferson Medical College of Thomas Jefferson University, Philadelphia, and lead author of the study, said in a press release announcing the results.

Mraovic and colleagues reviewed records for 6,538 patients who underwent either THR or TKR at the center from 2003 to 2005. Of these, 38 patients had hyperglycemia, defined as blood glucose levels over 250 mg/dl on both the day of preoperative testing and the day of surgery.

The researchers compared rates of pulmonary embolism among hyperglycemic patients to data for a control group of patients contained in the Pennsylvania Health Care Cost Containment Council database. This database contained records for all hip and knee replacement patients treated at the hospital in 2002, the study authors noted.

Mraovic presented the results at the annual meeting of the American Society of Anesthesiologists in Chicago.

The researchers found that hyperglycemic patients had a pulmonary embolism rate 6.2 times higher than the control group. Four of the 38 hyperglycemic patients, or 10.5%, developed pulmonary embolism, compared with only 1.7% of control patients (P<.001), according to the study.

Mraovic noted that physicians should be aware of the increased pulmonary emboli risk among hyperglycemic patients. Additionally, these patients should have their glucose levels under control both before and during surgery, he said.

For more information:

• Mraovic D, Miinarcik BA, Furlong K, et al. Preoperative hyperglycemia is a risk factor for pulmonary embolism after major orthopedic surgery. Presented at the annual meeting of the American Society of Anesthesiologists. Oct. 14-18, 2006. Chicago.