Perioperative Management of Jardiance Before Amputation Surgery
Jardiance (empagliflozin) should be discontinued at least 3 days prior to amputation surgery to reduce the risk of perioperative complications, particularly ketoacidosis. 1
Understanding Jardiance in the Surgical Context
Jardiance is an SGLT2 inhibitor used for diabetes management, not an anticoagulant as suggested in the expanded question. The FDA label specifically addresses surgical considerations:
- Temporary discontinuation is recommended for at least 3 days prior to scheduled surgery 1
- This recommendation is primarily to reduce the risk of diabetic ketoacidosis, which can occur even with normal blood glucose levels
- Ketoacidosis is a serious life-threatening condition that requires urgent hospitalization
Perioperative Management Protocol
Before Surgery:
- Stop Jardiance at least 3 days before amputation surgery 1
- Monitor blood glucose levels more frequently during this period
- Consider alternative glycemic control methods during the interruption period
Risk Factors Requiring Special Attention:
- Patients with impaired renal function
- Elderly patients
- Patients on loop diuretics
- These patients have increased risk for volume depletion or hypotension 1
After Surgery:
- Ensure risk factors for ketoacidosis are resolved before restarting Jardiance 1
- Confirm adequate oral intake and stable renal function
- Monitor for signs of surgical site infection, as SGLT2 inhibitors increase risk of infections
Important Considerations for Amputation Surgery
Amputation is considered a high bleeding risk procedure, which requires careful perioperative management:
- Assess volume status before surgery, as Jardiance can cause intravascular volume depletion 1
- Monitor for signs of urinary tract infections, which are more common with SGLT2 inhibitors 1
- Be vigilant for necrotizing fasciitis in the surgical area, a rare but serious complication associated with SGLT2 inhibitors 1
Common Pitfalls to Avoid
- Don't confuse Jardiance with anticoagulants: Jardiance is an SGLT2 inhibitor for diabetes management, not an anticoagulant
- Don't restart too early: Ensure surgical healing has begun and patient is stable before restarting
- Don't ignore signs of ketoacidosis: Monitor for nausea, vomiting, abdominal pain, malaise, and shortness of breath, even if blood glucose is <250 mg/dL 1
- Don't overlook volume status: Jardiance can cause dehydration, which may complicate surgical recovery 1
Following these guidelines will help minimize perioperative complications and optimize outcomes for patients undergoing amputation surgery while on Jardiance therapy.