{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:53Z","timestamp":1790553653105,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,2,21]]},"abstract":"\n Background:<\/jats:title>\n Hyperglycemia has been identified as a risk factor for periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, there is no consensus with regard to the preoperative blood glucose level (BGL) on the day of the surgical procedure associated with increased risk. We sought to identify preoperative BGL thresholds associated with an increased risk of PJI.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n The Premier Healthcare Database was retrospectively queried for adult patients who underwent primary, elective THA and had a measurement of the preoperative BGL recorded on the day of the surgical procedure (preoperative BGL) from January 1, 2016, to December 31, 2021. The association between preoperative BGL and 90-day PJI risk was modeled using multivariable logistic regression with restricted cubic splines. Patients with and without diabetes with a preoperative BGL associated with 1.5 times greater odds of PJI (high preoperative BGL) were then compared with patients with a normal preoperative BGL.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n In this study, 90,830 patients who underwent THA and had a recorded preoperative BGL were identified. The preoperative BGL associated with 1.5 times greater odds of PJI was found to be 277 mg\/dL in patients with diabetes and 193 mg\/dL in patients without diabetes. Compared with the normal preoperative BGL cohort, those with high preoperative BGL had increased odds of PJI (adjusted odds ratio [OR], 2.60 [95% confidence interval (CI), 1.45 to 4.67] for patients with diabetes and 1.66 [95% CI, 1.10 to 2.51] for patients without diabetes) and 90-day readmissions (adjusted OR, 1.92 [95% CI, 1.45 to 2.53] for patients with diabetes and 1.66 [95% CI, 1.37 to 2.00] for patients without diabetes).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Increased preoperative BGL was found to be associated with an increased risk of PJI following primary THA. Surgeons should be aware of patients with diabetes and a preoperative BGL of >277 mg\/dL and patients without diabetes but with a preoperative BGL of >193 mg\/dL.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Prognostic\n Level III<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.23.00546","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T14:10:25Z","timestamp":1703167825000},"page":"276-287","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":29,"title":["Higher Blood Glucose Levels on the Day of Surgery Are Associated with an Increased Risk of Periprosthetic Joint Infection After Total Hip Arthroplasty"],"prefix":"10.2106","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7142-604X","authenticated-orcid":false,"given":"Julian","family":"Wier","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3693-3274","authenticated-orcid":false,"given":"Mary K.","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7979-9289","authenticated-orcid":false,"given":"Brandon S.","family":"Gettleman","sequence":"additional","affiliation":[{"name":"University of South Carolina School of Medicine, Columbia, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5369-9038","authenticated-orcid":false,"given":"Natalie M.","family":"Kistler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-1702","authenticated-orcid":false,"given":"Nathanael D.","family":"Heckmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1374-8929","authenticated-orcid":false,"given":"Jay R.","family":"Lieberman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"issue":"7S","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"S337","DOI":"10.1016\/j.arth.2018.12.024","article-title":"Mortality during total hip periprosthetic joint infection","volume":"34","author":"Natsuhara","year":"2019","journal-title":"J Arthroplasty."},{"issue":"13","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.2106\/JBJS.17.00798","article-title":"Increased postoperative glucose variability is associated with adverse outcomes following total joint arthroplasty","volume":"100","author":"Shohat","year":"2018","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"2312","DOI":"10.1016\/j.arth.2018.02.020","article-title":"Inadequate glycemic control is associated with increased surgical site infection in total joint arthroplasty: a systematic review and meta-analysis","volume":"33","author":"Shohat","year":"2018","journal-title":"J Arthroplasty."},{"issue":"7S","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"S152","DOI":"10.1016\/j.arth.2019.01.004","article-title":"Optimal timing of glucose measurements after total joint arthroplasty","volume":"34","author":"Varady","year":"2019","journal-title":"J Arthroplasty."},{"issue":"51","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"e8805","DOI":"10.1097\/MD.0000000000008805","article-title":"Is hemoglobin A1c and perioperative hyperglycemia predictive of periprosthetic joint infection following total joint arthroplasty? 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