Hospitalized diabetic patients do worse than nondiabetic patients, and the level of inpatient hyperglycemia is associated with some of this excess morbidity. We endeavored to identify if preoperative hemoglobin A1c (HbA1c) could predict the risk of postoperative hyperglycemia in type 2 diabetic patients undergoing elective joint arthroplasty.
We retrospectively reviewed the charts of all patients who underwent elective hip or knee arthroplasty for the 1‐year period between July 1, 2003, and June 30, 2004, at the University of Colorado Hospital, identifying type 2 diabetic patients who had both an HbA1c level measured within the 6 months prior to the procedure and documented postoperative blood sugar measurements.
Twelve percent of patients (43 of 349) carried a diagnosis of diabetes, and 58% of diabetic patients (25/43), 11 who received hip arthroplasty and 14 who received knee arthroplasty, had an HbA1c recorded in the previous 6 months. Mean HbA1c was 7.1 (median 6.8, SD 1.7), and mean peak blood sugar was 253 mg/dL (SD 78 mg/dL). There was a correlation between preoperative HbA1c and mean peak blood sugar for the combined hip and knee cohort (r = 0.5133, P = .009) as well as the hip cohort alone (n = 11; r = 0.824, P = .0018). This correlation was not seen in the knee cohort (n = 14; r = 0.060, P = .8313).
Figure: Correlation of HbAlc to peak post‐operative blood sugan in allpatients undergoing elective joint arthroplasty
Diabetic patients with an HbAlc ≤ 6 (n = 5, range 4.5‐6) had a mean peak blood sugar of 157 mg/dL with 0% (0/5) experiencing a blood sugar > 220 mg/dL, a level associated with excess morbidity in orthopedic trauma patients. Patients with HbA1c levels between 6 and 7 (n = 10) had a mean peak blood sugar of 236 mg/dL, with 80% (8/10) experiencing a blood sugar > 220 mg/dL. Those with an HbA1c > 7 (n = 10, range 7.0‐13.2) had a mean peak blood sugar of 280 mg/dL, with 90% (9/10) having a blood sugar > 220 mg/dL. Overall, 85% of patients (17/20) with an HbA1c > 6 experienced at least 1 blood sugar > 220 mg/dL.
Preoperative HbA1c is a predictor of peak postoperative blood sugar observed in type 2 diabetic patients undergoing major joint replacement. This correlation was noted even in patients with modestly elevated preoperative HbA1c and was strong in the elective hip patients and absent in elective knee patients. Clinicians should exercise caution in recommending elective procedures to diabetic patients with abnormally elevated HbA1c levels and/or be prepared to aggressively manage postoperative glycemic control
J. J. Glasheen, Baxter Pharma, consulting fees or other remuneration (payment); Pfizer, consulting fees or other remuneration (payment); Astellas, speakers bureau; Cubist, consulting fees or other remuneration (payment); R. Sturges, None; J. Carter, None; C. Baumgartner, None; A. Prochazka, None.
To cite this abstract:Glasheen J, Sturges R, Carter J, Baumgartner C, Prochazka A. Predictive Value of Hemoglobin A1c in Type 2 Diabetic Patients Undergoing Elective Joint Arthroplasty. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 26. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/predictive-value-of-hemoglobin-a1c-in-type-2-diabetic-patients-undergoing-elective-joint-arthroplasty/. Accessed March 28, 2020.