Manejo de la hiperglicemia en candidatos a cirugía ortopédica

Abstract

It has been demonstrated that diabetes mellitus (DM) elevates the rates of morbidities, among which orthopedic disorders stand out due to their high prevalence, risk of complications, and mortality. However, hyperglycemia with or without the DM diagnosis appears to be by itself a predisposing factor for complications in orthopedic surgeries, as in cases with deficient glycemic management there is a greater risk of infections in the surgical site, periprosthetic and urinary infections, as well as an increase in amputations, pneumonia, ketoacidosis, and deep venous thrombosis. This is in addition to prolonged hospital stays and mortality. Thus, it is necessary to perform a correct glycemic management in candidates for orthopedic surgery in order to prevent these complications. To this end, international guidelines, along with recent research, highlight the importance of the serial measurement of blood glucose and HbA1C, with specialized treatment of these values. Finally, another innovative point in metabolic management is the continuous administration of oral antihyperglycemic drugs in the perioperative period, although further evidence is required. The application of insulin remains the ideal method for controlling hyperglycemia in surgical cases, especially in emergency procedures.