Monday, May 14, 2018

Diabetes, HbA1c, infection, and shoulder arthroplasty

Association of Perioperative Glycemic Control With Deep Postoperative Infection After Shoulder Arthroplasty in Patients With Diabetes (J Am Acad Orthop Surg 2018;0:1-8)

These authors queried the  PearlDiver Patient Records Databasefor patients with diabetes who underwent primary shoulder arthroplasty. They assessed the incidence of wound complications within 6 months within 1 year for each perioperative HbA1c level. 

Patients with DM had higher rates of wound complications (1.4% versus 0.9%; odds ratio, 1.22; P = 0.028) and deep infection (0.7% versus 0.4%; odds ratio, 1.47; P = 0.001). 

The rates of wound complications (P = 0.0008) and deep postoperative infection (P = 0.002) increased markedly as the perioperative HbA1c level increased. 

Comment: As the authors point out, the literature on the effects of preoperative optimization of HbA1c values and postoperative infection is lacking. Thus, while it seems compelling to do so, we cannot be sure that requiring our diabetic patients to 'get their HbA1c below 8' will lower their risk of infection.

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