This article is more than 5 years old. Information may no longer be current.
More than half of diabetic patients with high preop HbA1c levels were able to achieve threshold level for TJA
While the authors of this study found that most diabetic patients scheduled for total joint arthroplasty achieved a threshold hemoglobin A1c value of 7% or less, 59% of patients who had levels greater than this value and were delayed surgery were able to achieve this hemoglobin goal at a mean of approximately 4.5 months.
Through a retrospective chart review at a Veterans Affairs medical center, researchers referred patients with a hemoglobin A1c (HbA1c) of greater than 7% to their primary care provider for better diabetic control. Unless reduction of HbA1c to 7% or less was deemed medically inadvisable, patients underwent surgery only after they returned with an HbA1c of 7% or less.
Overall, 404 diabetic patients were scheduled for total joint arthroplasty. Researchers delayed surgery in 59 cases because of an HbA1c of greater than 7%. After a median of 141 days, 35 of these patients were able to reduce the HbA1c level to 7% or less while 24 failed to achieve this goal, according to study results. If researchers used an HbA1c goal of 8% or lower, the surgery would have been delayed in 30 cases and 21 patients would have achieved the goal.
“The increased risk of complications in patients with elevated HbA1c must be balanced against the fact that access to surgery can potentially alter the quality of life of diabetic patients,” the researchers wrote in their study. “Ultimately, surgeons must work with their diabetic patients to weigh the data becoming available on this important topic and decide how to balance risk and access to total joint arthroplasty.”
Disclosure: The researchers have no relevant financial disclosures.