The team recommended that physicians and researchers evaluate treating such at-risk patients before surgery to control blood sugar, reduce blood pressure and prevent dangerous clot formation, to reduce the likelihood of complications.
These findings have broad implications for the health care delivery system, the researchers said, since more than 700,000 major joint replacement surgeries are performed annually in the U.S. at a cost exceeding $10 billion. Furthermore, as the incidence of diabetes, hypertension and obesity increases and the population ages, orthopedic surgeons must expect to see not only more, but sicker, patients and they will need to know how to effectively treat them, said the researchers.
Of three conditions that the researchers studied, obesity conferred the highest risk of post-operative complications and the need for additional post-discharge care.
The findings of the Duke analysis were published June 1, 2005, in the journal Clinical Orthopaedics and Related Research.
"Hypertension, diabetes and obesity are important independent predictors of increased complications for patients undergoing major joint replacement surgery," said the study's first author Nitin Jain, M.D., currently a post-doctoral fellow at Brigham & Women's Hospital, Harvard Medical School. He conducted the study as a research associate in the laboratory of Duke orthopedic surgeon Laurence Higgins, M.D., senior member of the research team.
"The results of our study should may surgeons to more accurately predict which of their patients are most likely to have adverse outcomes after their surgery," Jain continued.
Contact: Richard Merritt
Duke University Medical Center