title: Is Hemoglobin A1c or Perioperative Hyperglycemia Predictive of Periprosthetic Joint Infection or Death Following Primary Total Joint Arthroplasty?
abstract: We sought to determine if HbA1c and perioperative hyperglycemia were positively associated with the incidence of PJI. We retrospectively reviewed the VA VINCI database on patients who underwent primary joint arthroplasty between 2001 and 2011 and had HbA1c and perioperative blood glucose levels. Of 13,272 patients, 38% (n=5035) had an elevated perioperative HbA1c ≥7%. While there was no increased risk of infection associated with elevated HbA1c (HR 0.86, P=0.23), mortality was increased (HR 1.3, P=0.01). Preoperative hyperglycemia was associated with an increased incidence of PJI (HR 1.44, P=0.008). While HbA1c did not perfectly correlate with the risk of PJI, perioperative hyperglycemia did, and may be a target for optimization to decrease the burden of PJI.
authors.affiliation: University of Utah, Department of Orthopaedics, Salt Lake City, Utah.
authors.forename: Jesse
authors.initials: J
authors.lastname: Chrastil
authors.affiliation: University of Utah, Department of Orthopaedics, Salt Lake City, Utah.
authors.forename: Mike B
authors.initials: MB
authors.lastname: Anderson
authors.affiliation: University of Utah, Pharmacotherapy Outcomes Research Center, College of Pharmacotherapy, Salt Lake City, Utah; IDEAS 2.0, Veterans Affairs Salt Lake City Health System, Salt Lake City, Utah.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Stevens
authors.affiliation: University of Utah, Department of Medicine, Salt Lake City, Utah.
authors.forename: Rahul
authors.initials: R
authors.lastname: Anand
authors.affiliation: University of Utah, Department of Orthopaedics, Salt Lake City, Utah.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters
authors.affiliation: University of Utah, Department of Orthopaedics, Salt Lake City, Utah.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Pelt
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D016459:Prosthesis-Related Infections / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000097:blood / Q000209:etiology*; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin
keywords: diabetes mellitus; hemoglobin A1c; perioperative glucose; periprosthetic joint infection; total joint arthroplasty