title: Hip surgery sequentially induces stress hyperglycaemia and activates coagulation.
abstract: BACKGROUND
  A frequent complication of orthopaedic procedures is venous thromboembolism (VTE ). Hyperglycaemia has been shown to activate the coagulation system and is associated with postoperative morbidity and mortality. Therefore, we hypothesised that glucose levels increase during orthopaedic surgery and are associated with an activation of the coagulation system.
  
  
  METHODS
  Nine adult patients undergoing elective hip replacement were included. Venous blood samples were taken before, during and after surgery. Plasma glucose levels, factor VIII clotting activity (fVIII:c), von Willebrand ristocetin cofactor activity, von Willebrand factor antigen and prothrombin fragment 1+2 were measured.
  
  
  RESULTS
  Immediately after induction of anaesthesia, plasma glucose levels started to increase until the second day postoperatively (peak 8.0 mmol/l). After seven weeks glucose values had returned to baseline (6.1 mmol/l), p<0.001 with ANOVA. All coagulation parameters increased during surgery, subsequent to the rise in glucose. The change in mean FVIII:c and von Willebrand ristocetin cofactor activity was significantly correlated with mean glucose values.
  
  
  CONCLUSIONS
  These observations indicate that total hip replacement surgery causes an increase in glucose levels that precedes the proportional rise of the measured coagulation parameters. This suggests a possible role of glucose in the activation of the coagulation system during hip surgery.
authors.affiliation: Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands. j.hermanides@amc.uva.nl
authors.forename: J
authors.initials: J
authors.lastname: Hermanides
authors.forename: R
authors.initials: R
authors.lastname: Huijgen
authors.forename: C P
authors.initials: CP
authors.lastname: Henny
authors.forename: N H
authors.initials: NH
authors.lastname: Mohammad
authors.forename: J B L
authors.initials: JB
authors.lastname: Hoekstra
authors.forename: M M
authors.initials: MM
authors.lastname: Levi
authors.forename: J H
authors.initials: JH
authors.lastname: DeVries
mesh_terms: D000704:Analysis of Variance; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001786:Blood Glucose; D016001:Confidence Intervals; D005169:Factor VIII; D006615:Hip / Q000601:surgery*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D019637:Orthopedic Procedures / Q000009:adverse effects; D012307:Risk Factors; D013223:Statistics as Topic; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000150:complications*; D013997:Time Factors; D054556:Venous Thromboembolism / Q000209:etiology*; D014841:von Willebrand Factor / Q000276:immunology
chemical_list: D001786:Blood Glucose; C029417:Von Willebrand antigen; D014841:von Willebrand Factor; D005169:Factor VIII