Is There an Association Between Hemoglobin A1C and Deep Postoperative Infection After TKA?

Abstract

Level III, diagnostic study.

Selecting and optimising patients for total knee arthroplasty

“…It appears that higher cut‐offs are required for routine HbA 1C screening to have predictive value. A retrospective study found a large increase in prosthetic infection in patients with HbA 1C levels > 60.7 mmol/mol, while another found an association at levels > 63.9 mmol/mol . Given these retrospective studies are subject to bias, there is no high level evidence to support the routine screening of glycaemic control in TKA candidates.…”

“…A retrospective study found a large increase in prosthetic infection in patients with HbA 1C levels > 60.7 mmol/mol, 99 while another found an association at levels > 63.9 mmol/mol. 100 Given these retrospective studies are subject to bias, there is no high level evidence to support the routine screening of glycaemic control in TKA candidates. However, when HbA 1c control is also combined with other factors, including evidence (or lack) of patient self-monitoring, and the presence of diabetic comorbidities, there is a significantly increased risk of multiple adverse events.…”

Impact of Perioperative HbA1c on Reimbursements in Diabetes Mellitus Patients Undergoing Total Hip Arthroplasty: A Nationwide Analysis

“…Complications following THA have been identified as one of the leading cost drivers [19]. It has been well studied that patients with DM undergoing THA are at an increased risk of complications such as superficial site infections, periprosthetic joint infections, aseptic loosening, increased length of stay, and increased total hospital costs [8,11,12,20]. A positive correlation between rising HbA1c levels and increased risk of infection and cost has been shown [21].…”

“…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].…”

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

“…A similar rationing of care is taking place regarding risk factors such as perioperative glucose control and tobacco use (Table 1). Preoperatively predicting perioperative glucose control remains challenging, however, and the validity of using hemoglobin A1c, which measures a collective 90‐days of serum glucose control, as a surrogate measure has recently been questioned 32–34 . Alternative tests such as perioperative serum glucose levels and fructosamine have been described as more sensitive measures of perioperative glucose control, and have demonstrated promise in preoperative screening for high‐risk patients 35,36 .…”