High Preoperative Glucose and Not Just Diabetes is an Independent Risk Factor For Pulmonary Embolism

We hypothesized that poor glycemic control preoperatively (blood glucose >200) may increase the incidence of pulmonary embolism (PE) after total joint arthroplasty. We retrospectively reviewed records of 7226 patients undergoing total joint arthroplasty from 2001 to 2006 at our institution. Multiple risk factor were analyzed which included: age, sex, body mass index, ASA status, duration of surgery, type of surgery (hip vs knee, revision vs primary, bilateral vs unilateral), all comorbidities, perioperative anticoagulation and preadmission glucose. The data were analyzed using logistic regression. The incidence of PE was 1.49% (108 patients). Multivariate analysis showed that preoperative glucose _200 mg/mL increased risk of PE by 2.7 when compared with patients with glucose ??110 mg/dL; older age (>64 years) increased risk by 2.2; and body mass index above 40 kg/m² increased risk by 2.2. Among cardiac comorbidities, only congestive heart failure increased risk for PE by 2.5. Total knee arthroplasty carried 2.4 times more risk than total hip arthroplasty. Bilateral procedure increased risk by 1.77. Revision surgeries did not increase risks compared with primary arthroplasty. All patients received postoperative deep venous thrombosis prophylaxis with warfarin per hospital protocol. Our data suggest that preoperative hyperglycemia is an independent risk factor for developing PE after major orthopedic surgery. We recommend that target glycemia level should be less than 200 mg/dL before any major orthopedic procedure. A prospective randomized controlled study would determine if tighter control of preoperative glucose leads to a further decrease in the incidence of PE incidence in this clinical setting.