title: A retrospective review of the assessment of current perioperative management of diabetes in patients undergoing knee replacement surgery.
abstract: OBJECTIVE
  The prevalence of diabetes mellitus is increasing. Previous work has shown that suboptimal glycaemic control is associated with poor perioperative outcomes with increased rates of postoperative morbidity and mortality in several surgical specialities. Recently published UK guidelines have laid out the standards of perioperative care for patients with diabetes. Because an increasing number of patients with diabetes undergo surgery, it is important that these nationally agreed standards of care are adhered to.
  
  
  METHODS
  A retrospective review of the standard of care of patients against existing audit standards laid down in national guidelines, and a comparison of outcomes with people without diabetes.
  
  
  METHODS
  A single major orthopaedic department.
  
  
  METHODS
  Fifty consecutive patients undergoing knee arthroplasty between July 2010 and June 2011.
  
  
  METHODS
  Postoperative complications; pre, peri and postoperative glucose control; hospital length of stay.
  
  
  RESULTS
  Although there were no serious postoperative complications, the pre, peri and postoperative management was found to be suboptimal, particularly with reference to optimization of blood glucose control, both in terms of HbA1c preoperatively and blood glucose monitoring perioperatively. The average length of hospital stay was not different between groups; however, 36 patients with diabetes had at least one documented hyperglycaemic episode and four at least one hypoglycaemic episode.
  
  
  CONCLUSIONS
  Perioperative care of diabetes in patients undergoing knee arthroplasty could be improved. Several changes have been made since this audit was carried out, in particular adoption of the comprehensive Joint British Diabetes Societies Guideline on the perioperative management of adult patients with diabetes.
authors: Department of Orthopaedic Surgery, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK.
authors: Alan J
authors: AJ
authors: Howieson
authors: Department of Orthopaedic Surgery, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK.
authors: Annmarie
authors: A
authors: Brunswicker
authors: Diabetes and Endocrinology, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK.
authors: Ketan
authors: K
authors: Dhatariya
keywords: diabetes; knee replacement; perioperative glucose control; surgery