Anesthesia Preoperative Clinic Referral for Elevated Hba1c Reduces Complication Rate in Diabetic Patients Undergoing
Peter J Kallio1, Jenea Nolan2, Amy C Olsen2
1Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA ; Department of Nursing, Marquette University, Wisconsin, USA.
Insights
Referral to an anesthesia preoperative clinic (APC) for elevated glycosylated hemoglobin (HbA1c) in diabetic patients undergoing total joint arthroplasty (TJA) significantly lowers complication rates and hospital stays.
Area of Science:
- Orthopedic Surgery
- Endocrinology
- Anesthesiology
Background:
- Diabetes mellitus (DM) is a significant risk factor for post-operative complications in orthopedic surgery.
- Effective management of DM is crucial for improving patient outcomes after procedures like total joint arthroplasty (TJA).
Purpose of the Study:
- To evaluate if referral to an anesthesia preoperative clinic (APC) for elevated glycosylated hemoglobin (HbA1c) reduces complication rates after TJA.
- To assess the impact of pre-operative diabetes control on post-surgical outcomes in TJA patients.
Main Methods:
- A retrospective study of 203 patients (with and without DM) undergoing TJA between 2006-2012.
- Patients were stratified based on APC referral and HbA1c levels, with interventions aimed at improving glycemic control before surgery.
- Post-operative complications, mortality, length of stay (LOS), and prolonged LOS were recorded and analyzed.
Main Results:
- DM patients with uncontrolled HbA1c or levels ≥10% had higher rates of coronary disease and hypercholesterolemia compared to non-diabetic patients.
- A higher complication rate was observed in DM patients with uncontrolled HbA1c versus controls (P < 0.001).
- Improved HbA1c control correlated with a progressive decrease in complication rates and reduced incidence of prolonged LOS.
Conclusions:
- APC referral for elevated HbA1c is effective in reducing complication rates in diabetic patients undergoing TJA.
- Pre-operative management of elevated HbA1c through APC referral leads to decreased prolonged hospitalization within the first year post-surgery.
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.
More Related Videos
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Diabetes Mellitus: Type 2 and Gestational