Jourdan M Cancienne1, Stephen F Brockmeier, Brian C Werner. 1. From the Department of Orthopaedic Surgery, the University of Virginia Health System (Dr. Cancienne), and the Department of Orthopaedic Surgery, the University of Virginia (Dr. Brockmeier and Dr. Werner) Charlottesville, VA.
Abstract
BACKGROUND: Although diabetes mellitus (DM) has been established as a risk factor for infection after lower extremity arthroplasty, no association has been reported with shoulder arthroplasty. METHODS: We queried a national database for patients with DM who underwent primary shoulder arthroplasty. We identified perioperative hemoglobin A1c (HbA1c) levels and assessed the incidence of wound complications within 6 months and deep infection that required surgical intervention within 1 year for each HbA1c level. We performed a receiver operating characteristic analysis to determine a threshold value of HbA1c. RESULTS: Patients with DM had markedly 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. Receiver operating characteristic analysis demonstrated an inflection point at an HbA1c level of 8.0 mg/dL (P = 0.017; sensitivity, 50%; specificity, 75%). CONCLUSIONS: The risk of wound complications and deep postoperative infection in patients with DM increases as the perioperative HbA1c level increases. An HbA1c level >8.0 mg/dL could serve as a threshold for a markedly increased risk of infection. LEVEL OF EVIDENCE: Therapeutic level III, case-control study, treatment study.
BACKGROUND: Although diabetes mellitus (DM) has been established as a risk factor for infection after lower extremity arthroplasty, no association has been reported with shoulder arthroplasty. METHODS: We queried a national database for patients with DM who underwent primary shoulder arthroplasty. We identified perioperative hemoglobin A1c (HbA1c) levels and assessed the incidence of wound complications within 6 months and deep infection that required surgical intervention within 1 year for each HbA1c level. We performed a receiver operating characteristic analysis to determine a threshold value of HbA1c. RESULTS:Patients with DM had markedly 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. Receiver operating characteristic analysis demonstrated an inflection point at an HbA1c level of 8.0 mg/dL (P = 0.017; sensitivity, 50%; specificity, 75%). CONCLUSIONS: The risk of wound complications and deep postoperative infection in patients with DM increases as the perioperative HbA1c level increases. An HbA1c level >8.0 mg/dL could serve as a threshold for a markedly increased risk of infection. LEVEL OF EVIDENCE: Therapeutic level III, case-control study, treatment study.
Authors: Matthew D McElvany; Priscilla H Chan; Heather A Prentice; Elizabeth W Paxton; Mark T Dillon; Ronald A Navarro Journal: Clin Orthop Relat Res Date: 2019-06 Impact factor: 4.176
Authors: Adam M Gordon; Keith B Diamond; Asad M Ashraf; Matthew L Magruder; Ramin Sadeghpour; Jack Choueka Journal: Eur J Orthop Surg Traumatol Date: 2022-08-11