Study identifies patient factors linked with post TJA wound complications

CHICAGO — Researchers who presented a retrospective review here that used a matched patient cohort found greater odds of wound complications after total joint arthroplasty (TJA) among patients with elevated mean perioperative blood glucose levels, maximum blood glucose measures or preoperative hemoglobin A1C levels.

“These data show increased odds ratios for wound complications following TJA with a mean blood glucose of greater than 200 [mg/dL or] a hemoglobin A1C of greater than 6.7 [%],” Louis S. Stryker, MD, of Charlotte, N.C., said during his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “We feel that these [findings] provide implications for the preoperative evaluation and care, and perioperative management of these patients, as well as providing potential guidelines for future investigations and study.”

Louis S. Stryker

Stryker and colleagues used their institution’s TJA database to indentify 30 patients who underwent elective, primary TJA between 2000 and 2011 and had wound complications within 30 days of their surgery. The patients also blood glucose levels recorded for at least 2 days in-hospital after arthroplasty and the hemoglobin A1C levels were from blood drawn within 3 months of their surgery. The researchers matched the cohort with a control group for various factors including age, gender, procedure, tourniquet use, surgical approach and use of antibiotics and cement.

The study revealed significantly higher mean blood glucose levels and maximum blood glucose measures in the study group compared to controls, Stryker said. There was no significant difference between the groups for hemoglobin A1C.

“Given the matched study design, we calculated odds ratios using what appeared to be natural thresholds within the dataset,” Stryker said. Using a mean blood glucose of greater than 200 mg/dL, maximum blood glucose of greater than 260 mg/dL and a hemoglobin A1C threshold of 6.7%, the investigators found odds ratios for wound complications following collective primary joint arthroplasty of 3.75, 3 and 9, respectively.

Reference:

Stryker LS. Paper #13. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.

Disclosure: Stryker has no relevant financial disclosures.