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Diabetes Linked to Joint Replacement Complications and Higher Costs

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Duke Health News 919-660-1306

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.

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