Diabetes and obesity in orthopaedic patients

Abstract

Diabetes and obesity are becoming more prevalent globally. The burden of these diseases on modern healthcare systems is projected to rise. Diabetes has multiple effects on the trauma workload, with patients being more likely to sustain injuries and exhibit a disordered physiological response. When these patients require surgical intervention, they face a higher risk of postoperative infection and mortality. Hyperglycaemia, even without pre-existing diabetes, is associated with worse trauma and surgical outcomes, including increased mortality. Authors therefore advocate for aggressive blood glucose control both preoperatively and postoperatively. There is an elevated risk of complications for patients with shoulder and elbow conditions, but not for those with wrist and hand conditions. Patients undergoing spinal, hip, knee, and especially foot and ankle procedures have a greater risk of prolonged surgical time, non-union, infection, and amputation. Medical interventions aimed at managing obesity appear to reduce the risk of complications, and certain medications are thought to influence bone healing. Bariatric surgery is advantageous, but the timing of orthopaedic surgery must be carefully planned to minimize risks. Research into the impact of diabetes and obesity in orthopaedics is expanding as the anticipated costs associated with managing diabetic patients have increased the pressure on healthcare systems.