Elevated postoperative blood glucose and preoperative hemoglobin a1c are associated with increased wound complications following total joint arthroplasty

Louis S. Stryker, Matthew P. Abdel, Mark E. Morrey, Melissa M. Morrow, Daryl J. Kor, Bernard F. Morrey

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Abstract

Background: Diabetes is an established risk factor for complications following total joint arthroplasty. However, the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following total joint arthroplasty is not well described. Methods: All patients undergoing elective primary total joint arthroplasty at our institution from 2004 through 2011 with both postoperative blood glucose and preoperative hemoglobin A1C levels were identified in a retrospective review. From among 1702 patients, those with wound complications within thirty days after the index arthroplasty were identified. A control group matched for exact age, sex, procedure, tourniquet use, surgical approach, and use of antibiotic cement was also created. Thirty patients met the study group inclusion criteria. The mean patient age was seventy-two years (range, fifty-three to eighty-nine years); the majority (53%) of patients were female. Results: The odds ratio for developing a wound complication was 3.75 (95% confidence interval, 1.25 to 11.22; p =0.02) in patients with a mean postoperative glucose of >200 mg/dL, 3.0 (95% confidence interval, 0.97 to 9.30; p = 0.08) in patients with a maximum postoperative blood glucose of >260 mg/dL, and 9.0 (95% confidence interval, 1.14 to 71.20; p = 0.03) in patients with a preoperative hemoglobin A1C value of >6.7%. Conclusions: Patients with a mean postoperative blood glucose of >200 mg/dL or a preoperative hemoglobin A1C level of >6.7% are at increased risk for wound complications following elective primary total joint arthroplasty. These results show that poor preoperative and postoperative glucose control is independently associated with wound complications. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. COPYRIGHT

Original languageEnglish (US)
Pages (from-to)808-814
Number of pages7
JournalJournal of Bone and Joint Surgery - Series A
Volume95
Issue number9
DOIs
StatePublished - May 1 2013
Externally publishedYes

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Arthroplasty
Blood Glucose
Hemoglobins
Joints
Wounds and Injuries
Confidence Intervals
Glucose
Tourniquets
Odds Ratio
Anti-Bacterial Agents
Control Groups

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

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Elevated postoperative blood glucose and preoperative hemoglobin a1c are associated with increased wound complications following total joint arthroplasty. / Stryker, Louis S.; Abdel, Matthew P.; Morrey, Mark E.; Morrow, Melissa M.; Kor, Daryl J.; Morrey, Bernard F.

In: Journal of Bone and Joint Surgery - Series A, Vol. 95, No. 9, 01.05.2013, p. 808-814.

Research output: Contribution to journalArticle

Stryker, Louis S. ; Abdel, Matthew P. ; Morrey, Mark E. ; Morrow, Melissa M. ; Kor, Daryl J. ; Morrey, Bernard F. / Elevated postoperative blood glucose and preoperative hemoglobin a1c are associated with increased wound complications following total joint arthroplasty. In: Journal of Bone and Joint Surgery - Series A. 2013 ; Vol. 95, No. 9. pp. 808-814.
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abstract = "Background: Diabetes is an established risk factor for complications following total joint arthroplasty. However, the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following total joint arthroplasty is not well described. Methods: All patients undergoing elective primary total joint arthroplasty at our institution from 2004 through 2011 with both postoperative blood glucose and preoperative hemoglobin A1C levels were identified in a retrospective review. From among 1702 patients, those with wound complications within thirty days after the index arthroplasty were identified. A control group matched for exact age, sex, procedure, tourniquet use, surgical approach, and use of antibiotic cement was also created. Thirty patients met the study group inclusion criteria. The mean patient age was seventy-two years (range, fifty-three to eighty-nine years); the majority (53{\%}) of patients were female. Results: The odds ratio for developing a wound complication was 3.75 (95{\%} confidence interval, 1.25 to 11.22; p =0.02) in patients with a mean postoperative glucose of >200 mg/dL, 3.0 (95{\%} confidence interval, 0.97 to 9.30; p = 0.08) in patients with a maximum postoperative blood glucose of >260 mg/dL, and 9.0 (95{\%} confidence interval, 1.14 to 71.20; p = 0.03) in patients with a preoperative hemoglobin A1C value of >6.7{\%}. Conclusions: Patients with a mean postoperative blood glucose of >200 mg/dL or a preoperative hemoglobin A1C level of >6.7{\%} are at increased risk for wound complications following elective primary total joint arthroplasty. These results show that poor preoperative and postoperative glucose control is independently associated with wound complications. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. COPYRIGHT",
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T1 - Elevated postoperative blood glucose and preoperative hemoglobin a1c are associated with increased wound complications following total joint arthroplasty

AU - Stryker, Louis S.

AU - Abdel, Matthew P.

AU - Morrey, Mark E.

AU - Morrow, Melissa M.

AU - Kor, Daryl J.

AU - Morrey, Bernard F.

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N2 - Background: Diabetes is an established risk factor for complications following total joint arthroplasty. However, the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following total joint arthroplasty is not well described. Methods: All patients undergoing elective primary total joint arthroplasty at our institution from 2004 through 2011 with both postoperative blood glucose and preoperative hemoglobin A1C levels were identified in a retrospective review. From among 1702 patients, those with wound complications within thirty days after the index arthroplasty were identified. A control group matched for exact age, sex, procedure, tourniquet use, surgical approach, and use of antibiotic cement was also created. Thirty patients met the study group inclusion criteria. The mean patient age was seventy-two years (range, fifty-three to eighty-nine years); the majority (53%) of patients were female. Results: The odds ratio for developing a wound complication was 3.75 (95% confidence interval, 1.25 to 11.22; p =0.02) in patients with a mean postoperative glucose of >200 mg/dL, 3.0 (95% confidence interval, 0.97 to 9.30; p = 0.08) in patients with a maximum postoperative blood glucose of >260 mg/dL, and 9.0 (95% confidence interval, 1.14 to 71.20; p = 0.03) in patients with a preoperative hemoglobin A1C value of >6.7%. Conclusions: Patients with a mean postoperative blood glucose of >200 mg/dL or a preoperative hemoglobin A1C level of >6.7% are at increased risk for wound complications following elective primary total joint arthroplasty. These results show that poor preoperative and postoperative glucose control is independently associated with wound complications. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. COPYRIGHT

AB - Background: Diabetes is an established risk factor for complications following total joint arthroplasty. However, the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following total joint arthroplasty is not well described. Methods: All patients undergoing elective primary total joint arthroplasty at our institution from 2004 through 2011 with both postoperative blood glucose and preoperative hemoglobin A1C levels were identified in a retrospective review. From among 1702 patients, those with wound complications within thirty days after the index arthroplasty were identified. A control group matched for exact age, sex, procedure, tourniquet use, surgical approach, and use of antibiotic cement was also created. Thirty patients met the study group inclusion criteria. The mean patient age was seventy-two years (range, fifty-three to eighty-nine years); the majority (53%) of patients were female. Results: The odds ratio for developing a wound complication was 3.75 (95% confidence interval, 1.25 to 11.22; p =0.02) in patients with a mean postoperative glucose of >200 mg/dL, 3.0 (95% confidence interval, 0.97 to 9.30; p = 0.08) in patients with a maximum postoperative blood glucose of >260 mg/dL, and 9.0 (95% confidence interval, 1.14 to 71.20; p = 0.03) in patients with a preoperative hemoglobin A1C value of >6.7%. Conclusions: Patients with a mean postoperative blood glucose of >200 mg/dL or a preoperative hemoglobin A1C level of >6.7% are at increased risk for wound complications following elective primary total joint arthroplasty. These results show that poor preoperative and postoperative glucose control is independently associated with wound complications. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. COPYRIGHT

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