Background:Diabetes mellitus (DM) is risk factor for complications after orthopedic surgery.Objectives:We tested the hypothesis that anesthesia preoperative clinic (APC) referral for elevated glycosylated hemoglobin (HbA1c) reduces complication rate after total joint arthroplasty (TJA).Patients and 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.

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Introduction:The authors performed videolaryngoscopy during the preoperative anesthesia clinic evaluation of a patient with chronic dyspnea, stridor, and a previous hemilaryngectomy scheduled to undergo a series of orthopedic surgery procedures for an infected knee arthroplasty. The findings proved crucial for determining airway management.Case Presentation:A 68-year-old man presented to the preoperative anesthesia clinic for work-up before anticipated removal of infected total knee arthroplasty hardware, placement of antibiotic spacers, incision and drainage procedures, and revision arthroplasty. The patient had previously undergone a hemilaryngectomy and tracheostomy (now closed) for squamous cell carcinoma of the right true vocal cord. The patient described chronic dyspnea with minimal exertion. Inspiratory and expiratory wheezes and intermittent inspiratory stridor were present. A transnasal videolaryngoscopy examination was performed using topical anesthesia and demonstrated significant supraglottic scarring, a narrowed glottis, and subglottic stenosis. A computed tomography study confirmed the presence of tracheomalacia with subglottic stenosis. A permanent tracheostomy was performed to establish a definitive airway before the knee arthroplasty was removed.Conclusions:The case illustrates that transnasal videolaryngoscopy conducted in the preoperative anesthesia clinic is capable of providing key information to guide airway management in patients with significant upper airway pathology.

Satisfaction remains one of the most frequently used and inconsistent measures in Information Systems research. These inconsistencies can create challenges for interpreting the results of satisfaction measures. These challenges are noticeable in the telemedicine literature where researchers often rely on single item measures of overall satisfaction. While researchers have attempted to address these issues by studying satisfaction's measurements and methodologies there remain gaps in the knowledge on how variations in measures may be interpreted regarding decision making. This research seeks to contribute to the knowledge in this area by investigating medical provider perspectives on single versus multidimensional measures of telemedicine satisfaction. Through a thematic analysis this research shows variations and similarities in decision making between measures across eleven themes. The results show not only variations in views but indicate subjective experiential interpretations of results. Findings along with implications for researchers and medical providers are discussed.