Is Hemoglobin A1c or Perioperative Hyperglycemia Predictive of Periprosthetic Joint Infection or Death Following Primary Total Joint Arthroplasty?

Chrastil, Jesse; Anderson, Mike B.; Stevens, Vanessa; Anand, Rahul; Peters, Christopher L.; Pelt, Christopher E.

doi:10.1016/j.arth.2015.01.040

Cited by 153 publications

(105 citation statements)

References 21 publications

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“…No significant association has been demonstrated between peri-operative HbA1c and peri-prosthetic infection at the hip or knee; however, both pre- and post-operative hyperglycemia have been associated with this serious complication [15•, 16]. Morning post-operative hyperglycemia >140 mg/dL(7.8 mmol/L) is associated with a 3-fold increased risk of peri-prosthetic infection (27/285 compared with 20/582) [17].…”

Section: Effect Of Glycemia On Outcomes For Orthopedic Surgerymentioning

confidence: 99%

Management of Hyperglycemia and Diabetes in Orthopedic Surgery

Akiboye

Rayman

2017

Curr Diab Rep

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An increasing number of orthopedic operations are being carried out in an older population in whom the prevalence of diabetes is dramatically increasing. People having surgery with diabetes and hyperglycemia are at increased risk of post-operative complications. The peri-operative risks have been well demonstrated for cardiac surgery and, more recently, for orthopedic surgery. This paper considers the issues surrounding orthopaedic surgery in patients with diabetes and the significance and management of hyperglycemia in the peri-operative period.

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Section: Effect Of Glycemia On Outcomes For Orthopedic Surgerymentioning

confidence: 99%

Management of Hyperglycemia and Diabetes in Orthopedic Surgery

Akiboye

Rayman

2017

Curr Diab Rep

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“…[21][22][23] In a large database on 13,272 patients who underwent primary joint arthroplasty between 2001 and 2011, Chrastil et al found was no increased risk of infection associated with elevated glycosylated hemoglobin, whereas preoperative hyperglycemia was associated with an increased incidence of perioperative joint infection again in keeping of a major risk of stress-induced hyperglycemia. 21 In a review article and meta-analysis of surgical procedures, Martin et al found an increased risk for surgical site infection associated with diabetes (OR, 1.53; 95% CI, 1.11-2.12), and lower values for orthopedic surgery (arthroplasty, OR 1, 26), but they also concluded for a higher risk associated with glucose levels, after controlling for the presence of diabetes. 22 The risk of adverse events associated with high SHR was particularly elevated in subjects without diabetes, who did not receive any treatment for their hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

<p>Stress Hyperglycemia and Complications Following Traumatic Injuries in Individuals With/Without Diabetes: The Case of Orthopedic Surgery</p>

Luzio¹,

Dusi²,

Mazzotti³

et al. 2020

DMSO

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Purpose: Hyperglycemia in trauma patients may stem from metabolic response to stress, both in the presence and the absence of underlying diabetes. We aimed to test the association of stress hyperglycemia with risks of adverse events subjects undergoing orthopedic surgery. Patients and Methods: In a prospective observational study, we enrolled 202 consecutive patients with hyperglycemia at hospital admission for trauma injuries requiring orthopedic surgery. Based on history, diabetes was present in 183, and 13 more were defined as unknown diabetes on the basis of HbA1c ≥48mmol/mol. Stress hyperglycemia was defined in subjects with/without diabetes by a stress hyperglycemia ratio (SHR) >1.14, calculated as admission glucose/average glucose, estimated from glycosylated hemoglobin. Logistic regression analysis was used to calculate the risk of post-surgery adverse events associated with different states of hyperglycemia, after correction for demographic and clinical confounders. Results: Stress hyperglycemia was diagnosed, either as superimposed to diabetes (54/196 cases, 27.6%) as well as in the 6 cases without diabetes. At least one complication was recorded in 68 cases (33.7%), the most common being systemic infection (22.8% of cases). In the total cohort, stress hyperglycemia, irrespective of the presence of diabetes, increased the risk of adverse events (any events, odds ratio [OR], 4.43; 95% confidence interval [CI], 2.11-9.30), cardiovascular events (OR, 7.09; 95% CI, 2.47-19.91), systemic infections (OR, 4.21; 95% CI, 1.97-9.03) and other adverse events (OR, 6.30; 95% CI, 1.41-28.03), after adjustment for confounders; hospital stay was much longer. The same was true when the analysis was limited to the diabetes cohort or by comparing pure stress hyperglycemia vs diabetes without stress hyperglycemia. Conclusion: The study highlights the importance of stress hyperglycemia for adverse events in the setting of orthopedic surgery following trauma injuries. This condition requires stricter management, considering the much longer length of hospital stay and higher costs.

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“…With the current healthcare climate, the development of APM pathways have focused on decreasing the cost of procedures while increasing the overall value [2]. DM has been identified as one of the most prevalent risk factors for increased complications and is estimated that greater than 22% of arthroplasty patients carry the diagnosis [9–11]. As such, the purpose of this study is to investigate the effect of various HbA1c levels on reimbursement payments following primary THA.…”

Section: Discussionmentioning

confidence: 99%

“…An HbA1c level of 8 mg/dL has been shown to be associated with an increased risk of deep postoperative infections following THA [8,20]. Furthermore, HbA1c greater than 8 mg/dL correlates with an increased mortality [9]. Nussenbaum et al [22] reported the results of 475 THA veteran patients before and after the implementation of cutoff criteria including HbA1c ≤ 7, hemoglobin ≥ 11, body mass index ≤ 35, and albumin ≥ 3.5.…”

Section: Discussionmentioning

confidence: 99%