title: Anesthesia Preoperative Clinic Referral for Elevated Hba1c Reduces Complication Rate in Diabetic Patients Undergoing Total Joint Arthroplasty.
abstract: BACKGROUND
  Diabetes mellitus (DM) is risk factor for complications after orthopedic surgery.
  
  
  OBJECTIVE
  We tested the hypothesis that anesthesia preoperative clinic (APC) referral for elevated glycosylated hemoglobin (HbA1c) reduces complication rate after total joint arthroplasty (TJA).
  
  
  METHODS
  Patients (n = 203) with and without DM were chosen from 1,237 patients undergoing TJA during 2006 - 12. Patients evaluated in the APC had surgery in 2006 - 8 regardless of HbA1c (uncontrolled). Those evaluated between in subsequent two-year intervals were referred to primary care for HbA1c ≥ 10% and ≥ 8%, respectively, to improve DM control before surgery. Complications and mortality were quantified postoperatively and at three, six, and twelve months. Length of stay (LOS) and patients requiring a prolonged LOS (> 5 days) were recorded.
  
  
  RESULTS
  Patients (197 men, 6 women) underwent 71, 131, and 1 total hip, knee, and shoulder replacements, respectively. Patients undergoing TJA with uncontrolled HbA1c and those with HbA1c < 10%, but not those with HbA1c < 8%, had a higher incidence of coronary disease and hypercholesterolemia than patients without DM. An increase in complication rate was observed in DM patients with uncontrolled HbA1c versus patients without DM (P < 0.001); the complication rate progressively decreased with tighter HbA1c control. More DM patients with preoperative HbA1c that was uncontrolled or ≥ 10% required prolonged LOS versus those without DM (P < 0.001 and P = 0.0404, respectively).
  
  
  CONCLUSIONS
  APC referral for elevated HbA1c reduces complication rate and the incidence of prolonged hospitalization during the first year after surgery in diabetics undergoing TJA.
authors.affiliation: Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA ; Department of Nursing, Marquette University, Wisconsin, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kallio
authors.affiliation: The School of Nurse Anesthesia, Rosalind Franklin University is located in Chicago, Illinois, USA.
authors.forename: Jenea
authors.initials: J
authors.lastname: Nolan
authors.affiliation: The School of Nurse Anesthesia, Rosalind Franklin University is located in Chicago, Illinois, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Olsen
authors.affiliation: Department of Nursing, Marquette University, Wisconsin, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Breakwell
authors.affiliation: Department of Nursing, Marquette University, Wisconsin, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Topp
authors.affiliation: Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Pagel
keywords: Arthroplasty; Diabetes Mellitus; Glycosylated Hemoglobin; Orthopedic Surgery