Elevated HbA1c is not a risk factor for wound complications following total joint arthroplasty: a prospective study

Abstract

Background: Controversies exist regarding the association of elevated serum glycated haemoglobin (HbA1c) levels and postoperative surgical site infection (SSI) or prosthetic joint infection (PJI) in the setting of total hip and knee arthroplasty (THA and TKA). The purpose of the current study was to determine the prevalence of unknown and uncontrolled diabetes mellitus (DM) in a consecutive series and to investigate the association between postoperative wound complications or SSI/PJI and elevated HbA1c in patients undergoing TJA. Methods: In this prospective single-centre study, HbA1c was determined for patients undergoing elective primary, aseptic or septic revision THA and TKA, between September 2017 and March 2018. Prevalence of DM, unknown and uncontrolled diabetes were reported. Occurrence of 90-day wound healing disorders (WHD) as well as SSI or PJI were observed. Considering the HbA1c threshold ⩾6.5%, a comparative analysis between patients with and without WHD and SSI or PJI for the whole study cohort, as well as for each arthroplasty group, was performed. Receiver operating characteristic (ROC) curves were developed to quantify the predictive power of HbA1c with regard to WHD and infection complications. A total of 1488 patients were included for final analysis. There were 1127 primary THA and TKA (75.7%), 272 aseptic revisions (18.3%) and 89 septic revisions (6.0%). The known diabetic patients constituted 9.9% of the whole study cohort. Results: The majority had uncontrolled DM (67%). Prevalence of unknown DM was 11.1%. The results reveal the prevalence for the German population and might be different in other regions. A total of 57 patients (3.7%) experienced postoperative wound or infectious complications. PJI occurred in only 5 patients (0.03%). There was no significant difference between patients with HbA1c <6.5% and patients with HbA1c ⩾6.5% ( p = 0.092). Conclusions: We demonstrated that prevalence of unknown and uncontrolled DM in patients undergoing TJA is increasing, however; routine preoperative determination of the HbA1c value to prevent possible postoperative wound or infectious complications remains debatable. Larger studies investigating the optimal HbA1c level, as well as other predictors are required.

Application of Different Doses of Tranexamic Acid Plus Traditional Chinese Medicine in Hip Arthroplasty in Patients with Diabetes and Its Influence on Intraoperative Blood Loss and Postoperative Drainage

“…However, due to the rich blood supply around the hip joint, intraoperative soft tissue dissection and intracavitary marrow expansion are associated with intraoperative hemorrhage, which requires blood transfusion to maintain effective circulating blood volume [ 1 – 3 ]. Although blood transfusion relieves the organ burden caused by massive blood loss, patients are predisposed to complications such as immune reaction and autohemolysis [ 4 , 5 ], especially for those with underlying diseases such as diabetes mellitus where blood transfusion is insufficient to reduce their surgical risk. Diabetic patients generally have poor surgical tolerance due to the long-term hyperglycemia of the organism, and massive intraoperative blood loss leads to cardiac and renal dysfunction and poor wound healing, thereby increasing the perioperative mortality of patients [ 6 , 7 ].…”

Patients with insulin-dependent diabetes are at greater risk for perioperative adverse outcomes following total hip arthroplasty

“…Several recent studies have investigated the impact of diabetes on outcomes after total joint arthroplasty. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] The ideal future study of this topic might include measures of preoperative and perioperative glycaemic control, preoperative and perioperative use of insulin, and THA-specific outcomes at longer follow-up. Such a study might determine which data have the greatest predictive value and might identify modifiable risk factors for future quality improvement initiatives.…”

Preoperative hemoglobin A1c and perioperative blood glucose in patients with diabetes mellitus undergoing spinal cord stimulation surgery: A literature review of surgical site infection risk

“…20,32,36,39,42 There was a total of five prospective studies, of which four did not find a correlation between preoperative HbA1c levels and increased incidence of SSI. 20,24,27,41,43 The single prospective study that did find a positive correlation involved 50 patients who underwent a variety of elective surgical operations. 20 The authors reported that patients with HbA1c >7% had a higher incidence of SSI, but also noted that these same patients had wider postoperative glycemic variability and higher preoperative and postoperative blood glucose levels.…”