title: Effect of preoperative hemoglobin A(1c) level on acute postoperative complications of total joint arthroplasty.
abstract: Diabetes mellitus is a well-established risk factor for postoperative complications of total joint arthroplasty (TJA). We conducted a study to identify a specific hemoglobin A1c (HbA1c) level at which immediate postoperative complication rates increased after TJA. HbA1c levels were measured within 90 days preoperatively. Complications were documented during the acute postoperative period. Charts were reviewed, and each patient was given a score based on how many of these postoperative complications occurred. Overall, 1118 patients were retrospectively analyzed between 2009 and 2011. Patients were grouped into 5 HbA1c level ranges, and a mean postoperative complication point score was obtained for each group. We found that mean postoperative complication rates increased along with HbA1c levels; HbA1c levels higher than 7.5% correlate strongly with a higher rate of postoperative complications. These findings provide a good foundation for prospective studies and further evidence of the effects of HbA1c levels. If an adequate treatment plan for these patients emerges, these findings may help lower readmission rates as well.
authors.affiliation: Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania. jdurinka@aol.com.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Goldstein
authors.forename: Joel B
authors.initials: JB
authors.lastname: Durinka
authors.forename: Nicole
authors.initials: N
authors.lastname: Martino
authors.forename: Jack W
authors.initials: JW
authors.lastname: Shilling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human