By Jennifer Warner – People with certain medical conditions need to take special care to prevent complications from joint replacement surgery.
Researchers say these findings have major implications for the more than 700,000 annual joint replacement surgeries, including those of the shoulder, knee, and hip joints. They found that people with diabetes, high blood pressure, and obesity are much more likely to have problems following joint replacement surgery.
The findings show that doctors should be aggressive about controlling blood sugar, reducing blood pressure, and preventing blood clots in order to reduce the risk of dangerous complications after joint replacement surgery.
Predicting Joint Replacement Risks
Researchers used a database of nearly 1 million Americans who had shoulder, hip, or knee joint replacement surgery to determine what factors affected the likelihood of complications after the procedure. The study appears in the current issue of the journal Clinical Orthopaedics and Related Research.
The results showed that high blood pressure, diabetes, and obesity were all important predictors of increased complications for people undergoing joint replacement surgery.
Of these three, obesity was associated with the highest risk of post-surgery complications and the need for additional care after hospital discharge.
For example, the study showed that 3.7 percent of obese patients experienced in-hospital complications after joint replacement surgery compared with 2.6 percent of non-obese patients.
Overall, post-surgery complications were 30 percent more likely in people with diabetes, 50 percent more likely in obese patients, and 10 percent more likely in people with high blood pressure. Complications included infection and blood clots.
In addition, researchers found that the likelihood of “nonroutine” discharge from the hospital was 30 percent higher for people with diabetes and 45 percent in obese patients. For those who were both obese and had diabetes, the additional risk jumped to 75 percent. Nonroutine discharges are when the patient is discharged to another facility for further medical care, such as to intermediate-care facilities or home health care.
"With this knowledge, surgeons should not only be able to better counsel their patients before surgery but also consider strategies during and after surgery to ensure better outcomes. However, the risks and benefits of a joint replacement procedure should be weighed by surgeons on an individual patient basis," says researcher Nitin Jain, MD, MSPH, a post-doctoral fellow at Brigham & Women's Hospital, in a news release.
SOURCES: Jain, N. Clinical Orthopaedics and Related Research, June 1, 2005; vol 431. News release, Duke University Medical Center.