Preadmission Hyperglycemia is an Independent Risk Factor for In-Hospital Symptomatic Pulmonary Embolism After Major Orthopedic Surgery

We investigate whether preadmission hyperglycemia is a risk factor for developing in-hospital symptomatic pulmonary embolism after major orthopedic surgery. Medical records of patients undergoing total hip or total knee arthroplasty from January 2001 to April 2006 were reviewed. The incidence of PE was 1.47% (107/7282 patients). Multivariate analysis showed that preadmission blood glucose (BG) of at least 200 mg/dL independently increased the risk of pulmonary embolism by 3.19 times ( P = .015), when compared with patients with BG of less than 110 mg/dL. Other significant risks factors were age (≥70 years old), body mass index of more than 30 kg/m 2, and congestive heart failure. Total knee had 2.19 times ( P = .002) more risk than total hip arthroplasty and bilateral procedure increased the risk by 2.13 times ( P = .015). Sex, American Society of Anesthesiologists status, duration of surgery, malignancy, pulmonary disease, hypertension, diabetes mellitus, dyslipidemia, sleep apnea, and stroke were not found to be significant risk factors for pulmonary embolism

Metabolic syndrome increases risk for pulmonary embolism after hip and knee arthroplasty

Aim To investigate whether patients with metabolic syndrome (MetS) undergoing total hip or knee replacement have an increased risk for pulmonary embolism (PE). Methods We studied patients undergoing total hip or total knee replacement from January 2001 to April 2006. The diagnosis of PE was based on a positive finding with a chest CT or a lung scan. Components of MetS were defined as 1) BMI≥30 kg/m2, 2) non-fasting preadmission glucose ≥11.1 mmol/L or diagnosis of diabetes, 3) hypertension, and 4) dyslipidemia. MetS was diagnosed if at least three of these components were present. Results Of 7282 patients, 107 (1.47%) were diagnosed with PE. The incidence of PE in patients with 0, 1, 2, 3, and 4 MetS components was respectively 0.85% (16/1888; 95% confidence interval [CI] 0.5%-1.4%), 1.24% (31/2500; 95% CI 0.9%-1.8%), 1.76% (34/1936; 95% CI 1.2%-2.5%), 2.64% (21/796; 95% CI 1.7%-4.1%), and 3.09% (5/162; 95% CI 1.1%-7.4%). The independent risk factors for PE were age ≥70, knee as opposite to hip replacement, bilateral knee surgery, congestive heart failure, and MetS or the number of MetS components. The odds of PE independently increased 1.6 times (95% CI 1.01-2.56; P = 0.043) for patients with MetS and 1.23 times (95% CI 1.02-1.48; P = 0.028) per each additional MetS component. Conclusion Patients with MetS are at increased risk for PE after total joint arthroplasty. The increasing number of MetS components significantly increased the incidence of PE

Clinical Accuracy of a Hospital Point-of-Care Glucose Meter

Summary: Glucose meter performance was evaluated against the ISO 15197 guidelines in 221 time-matched venous and capillary blood samples. Accuracy decreased when the source of the reference and meter blood samples was not the same