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Anesth Pain Med. 2015 Jun 22;5(3):e24376. doi: 10.5812/aapm.5(3)2015.24376. eCollection 2015 Jun.

Anesthesia Preoperative Clinic Referral for Elevated Hba1c Reduces Complication Rate in Diabetic Patients Undergoing Total Joint Arthroplasty.

Author information

1
Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA ; Department of Nursing, Marquette University, Wisconsin, USA.
2
The School of Nurse Anesthesia, Rosalind Franklin University is located in Chicago, Illinois, USA.
3
Department of Nursing, Marquette University, Wisconsin, USA.
4
Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.

Abstract

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.

KEYWORDS:

Arthroplasty; Diabetes Mellitus; Glycosylated Hemoglobin; Orthopedic Surgery

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