The results confirm our hypothesis that, regardless of type, patients with uncontrolled diabetes demonstrate significantly more perioperative complications as compared with patients with controlled diabetes or patients without diabetes, Dr. Milford H. Marchant Jr. from Duke University Medical Center, Durham, North Carolina, and colleagues note in their report.

To further support the findings, the investigators retrospectively analyzed the impact of glycemic control on various outcomes after total joint arthroplasty in 920,555 non-diabetic patients, 105,485 patients with controlled diabetes, and 3973 patients with uncontrolled diabetes who underwent total hip or knee replacement between 1988 and 2005.

The study found that compared with patients with controlled diabetes, patients with uncontrolled diabetes had a significantly higher odds of stroke (adjusted OR, 3.42), urinary tract infection (adjusted OR, 1.97), ileus (adjusted OR, 2.47), wound infection (adjusted OR, 2.28), postoperative hemorrhage (adjusted OR, 1.97), transfusion (adjusted OR, 1.19), and death (adjusted OR, 3.23).

It did not matter if the patient had type 1 or type 2 diabetes, Dr. Marchant noted in a statement. Regardless of diabetes type, we found that patients had fewer complications after surgery if their glucose level was controlled before, during and after surgery.

In addition, significantly lower hospital charges were incurred by patients without diabetes than those with diabetes. Controlled diabetic patients had significantly shorter hospital stays than patients with uncontrolled diabetes (p < 0.0001 for both).

It is crucial that patients have glucose levels well-managed before, during and after surgery, because it reduces the potential of having a complication, Dr. Marchant said. This is the responsibility of both the patient and the surgeon and it should be a priority.