Assessment for Perioperative Hyperglycemia Prior to Total Joint Replacement in Patients With and Without Diabetes

Lindsey A Macfarlane,Jeffrey N Katz,Joyce Lii,Seoyoung C Kim,Yinzhu Jin,Patricia D Franklin

doi:10.1001/jamanetworkopen.2019.10589

Abstract

This cohort study examines rates of screening for hyperglycemia before total joint replacement among Medicare enrollees with and without diabetes.

Highlights

More than 1 000 000 total joint replacements (TJRs) are performed annually in the United States,1 most of which are for osteoarthritis.2 Diabetes is a frequent comorbidity in patients with osteoarthritis3 and suboptimal glucose control preoperatively is associated with poor TJR outcomes.4,5 Despite the concern for hyperglycemia in the period before TJR, there is a paucity of data regarding the frequency of preoperative outpatient screening
The index date was the date of first TJR during the study period
In the 90 days prior to TJR, 4.9% of patients without diabetes had hemoglobin A1c (HbA1c) testing compared with 25.8% of those with diabetes not receiving medication, 39.0% of those with diabetes receiving noninsulin medications, and 43.4% of those with diabetes receiving insulin

Summary

Introduction

More than 1 000 000 total joint replacements (TJRs) are performed annually in the United States, most of which are for osteoarthritis. Diabetes is a frequent comorbidity in patients with osteoarthritis and suboptimal glucose control preoperatively is associated with poor TJR outcomes. Despite the concern for hyperglycemia in the period before TJR, there is a paucity of data regarding the frequency of preoperative outpatient screening. More than 1 000 000 total joint replacements (TJRs) are performed annually in the United States, most of which are for osteoarthritis.. Diabetes is a frequent comorbidity in patients with osteoarthritis and suboptimal glucose control preoperatively is associated with poor TJR outcomes.. Despite the concern for hyperglycemia in the period before TJR, there is a paucity of data regarding the frequency of preoperative outpatient screening. We aimed to assess how frequently hemoglobin A1c (HbA1c) was measured 90 days prior to TJR among Medicare enrollees. Author affiliations and article information are listed at the end of this article

Objectives

Methods

Results