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Association of Perioperative Glycemic Control With Deep Postoperative Infection After Shoulder Arthroplasty in Patients With Diabetes

Cancienne, Jourdan, M., MD; Brockmeier, Stephen, F., MD; Werner, Brian, C., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: June 1, 2018 - Volume 26 - Issue 11 - p e238–e245
doi: 10.5435/JAAOS-D-16-00784
Research Article

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

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.

Correspondence to Dr. Cancienne:

Dr. Brockmeier is a member of a speakers' bureau or has made paid presentations on behalf of Arthrex, Biomet, DePuy, and Zimmer; serves as a paid consultant to Biomet, MicroAire Surgical Instruments, and Zimmer; has received research support as a principal investigator from Arthrex, Biomet, and Tornier; has received royalties and financial or material support from Springer and Medical/Orthopaedic publications editorial/governing board (Journal of Bone and Joint Surgery—American, Orthopaedic Journal of Sports Medicine, and Techniques in Shoulder and Elbow Surgery); and is a board member or committee member of the American Orthopaedic Society for Sports Medicine; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; and MidAtlantic Shoulder and Elbow Society. None of the following authors or any of their immediate family members has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Cancienne and Dr. Werner.

© 2018 by American Academy of Orthopaedic Surgeons
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