title: Hemoglobin A1C as a marker for surgical risk in diabetic patients undergoing total joint arthroplasty.
abstract: Diabetes is a risk factor for complications following total joint arthroplasty (TJA). This retrospective cohort study of 6088 diabetic patients from the Veterans Health Administration (VHA) undergoing TJA sought to determine if hemoglobin A1c, an accessible and objective lab value, has utility as a predictor of risk of complications in TJA after controlling for demographic, surgical, and medical center effects, and to evaluate the benefits and risks of alternative thresholds. Analysis of the functional relationship between hemoglobin A1c and complications revealed that the risk linearly increases through, rather than surging at, the threshold of 7%. Before delaying surgery to achieve better diabetic control, surgeons and patients should weigh the estimated risks of TJA against the potential benefits.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California; Department of Orthopedic Surgery, Stanford University, Stanford, California.
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Bowe
authors.forename: Shalini
authors.initials: S
authors.lastname: Gupta
authors.forename: Laura S
authors.initials: LS
authors.lastname: Ellerbe
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Giori
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin
keywords: diabetes; hemoglobin A1C; total joint arthroplasty