Effect of Preoperative Hemoglobin A1c Level on Acute Postoperative Complications of Total Joint Arthroplasty

Diabetes mellitus is a well-established risk factor for postoperative complications of total joint arthroplasty (TJA). We conducted a study to identify a specific hemoglobin A_1c (HbA_1c) level at which immediate postoperative complication rates increased after TJA.

HbA_1c levels were measured within 90 days preoperatively. Complications were documented during the acute postoperative period. Charts were reviewed, and each patient was given a score based on how many of these postoperative complications occurred.

Overall, 1118 patients were retrospectively analyzed between 2009 and 2011. Patients were grouped into 5 HbA_1c level ranges, and a mean postoperative complication point score was obtained for each group. We found that mean postoperative complication rates increased along with HbA_1c levels; HbA_1c levels higher than 7.5% correlate strongly with a higher rate of postoperative complications.

These findings provide a good foundation for prospective studies and further evidence of the effects of HbA_1c levels. If an adequate treatment plan for these patients emerges, these findings may help lower readmission rates as well.