gms | German Medical Science

Objectives: Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors are gaining increasing popularity in treatment of type 2 diabetes mellitus (DM2). Due to potential cardiovascular and renal benefits treatment indications have expanded. However, SLGT2-Inhibitors may cause a rare and severe adverse effect: euglycemic diabetic ketoacidosis (euDKA). Among others, risk factors include reduced food and fluid intake and perioperative situations. Thus, professional societies recommend pausing SLGT2-Inhibitors prior to surgery. Up to now, only a small number of case reports have been published on postoperative euDKA, mostly in non-orthopedic patients. Conditions like hip fractures require urgent surgical care to optimize results, allowing not enough time to pause SGLT2-Inhibitors prior to surgery. The aim of this study is to evaluate patients with SGLT2-Inhibitors in relation to urgent surgeries due to acute hip fractures.

Methods: A retrospective chart review was performed of all patients who were admitted for acute hip fractures between 2021 and 2023. Patients were screened for DM2 as a comorbidity and SGLT2-Inhibitors in their medication regimen. Demographics, diagnosis, admission date and time and discharge date, information on the use of antidiabetic medications (SGLT2 inhibitors, metformin, insulin), type, time to and duration of surgery were documented. Postoperative data included admission/discharge date to the Intensive Care Unit (ICU), presence of complications (such as pneumonia, renal failure, and sepsis) and the occurrence of euDKA.

Results: In total 9 individuals met our inclusion criteria. Male patients were dominant (66%) with a median age of 74 years (IQR 60–83). On average patients were discharged after 12 days (4–21). Most patients took Empagliflozin (77.7%) in a combination with Metformin (44%) and/or Insulin (66%). Medial femoral neck fractures were most dominant (55,5%), second to pertrochanteric fractures (44,4%). Time to surgery was 857 min (IQR 392–1,180), mean duration of surgery was 86 min (37–167). Over half of all patients (55.5%) were admitted to the ICU postoperatively as a precaution with most stays there being one day long and an overall length of stay of 3.8 days (1–19). One patient experienced a decompensated heart insufficiency as a complication, resulting in a prolonged ICU stay. Over the observation period no euDKA were recorded.

Conclusion: Acute hip fractures usually require urgent surgical. Despite SGLT2-Inhibitor usage and inability to wean preoperatively, we found no cases of euglycemic diabetic ketoacidosis in our study. Thus, routine postoperative ICU observation solely due to SGLT2-Inhibitor intake may not be necessary. Of course, a larger longitudinal involving a larger cohort size would be helpful to assess for incidence and risk factors of euDKA of patients presenting with need for acute fracture care.