anesthesia preoperative clinic referral for elevated hba1c reduces complication rate in diabetic patients undergoing total joint arthroplasty

Background: diabetes mellitus (dm) is risk factor for complications after orthopedic surgery. objectives: we tested the hypothesis that anesthesia preoperative clinic (apc) referral for elevated glycosylated hemoglobin (hba1c) reduces complication rate after total joint arthroplasty (tja). patients and methods: patients (n = 203) with and without dm were chosen from 1,237 patients undergoing tja during 2006 - 12. patients evaluated in the apc had surgery in 2006 - 8 regardless of hba1c (uncontrolled). those evaluated between in subsequent two-year intervals were referred to primary care for hba1c ≥ 10% and ≥ 8%, respectively, to improve dm control before surgery. complications and mortality were quantified postoperatively and at three, six, and twelve months. length of stay (los) and patients requiring a prolonged los (> 5 days) were recorded. results: patients (197 men, 6 women) underwent 71, 131, and 1 total hip, knee, and shoulder replacements, respectively. patients undergoing tja with uncontrolled hba1c and those with hba1c < 10%, but not those with hba1c < 8%, had a higher incidence of coronary disease and hypercholesterolemia than patients without dm. an increase in complication rate was observed in dm patients with uncontrolled hba1c versus patients without dm (p < 0.001); the complication rate progressively decreased with tighter hba1c control. more dm patients with preoperative hba1c that was uncontrolled or ≥ 10% required prolonged los versus those without dm (p < 0.001 and p = 0.0404, respectively). conclusions: apc referral for elevated hba1c reduces complication rate and the incidence of prolonged hospitalization during the first year after surgery in diabetics undergoing tja.