The Creation of Data-Driven Preoperative Hemoglobin A1c and Same-Day Glucose Strata to Stratify Complication Risk Following Total Hip Arthroplasty

Authors

Madeline C. Rocks, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Amy Y. Zhao, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Ivan Z. Liu, Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, Georgia.
Amil R. Agarwal, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Andrew B. Harris, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Alex Gu, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Anthony S. Unger, Washington Orthopaedics and Sports Medicine, Washington, District of Columbia; Gildenhorn Institute for Bone and Joint Health at Sibley Memorial Hospital, Washington, District of Columbia.
Savyasachi C. Thakkar, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Document Type

Journal Article

Publication Date

10-21-2023

Journal

The Journal of arthroplasty

DOI

10.1016/j.arth.2023.10.024

Keywords

HbA1c; risk-stratification; same-day glucose; stratum specific likelihood ratio; total hip arthroplasty

Abstract

BACKGROUND: This study identifies data-driven strata for preoperative Hemoglobin A1c (HbA1c) and same-day glucose levels that maximize differences in the likelihood of complications following total hip arthroplasty (THA). METHODS: Patients who underwent THA from 2013 to 2022 were identified using a national database. In total, 18,728 patients were identified with a mean age of 67 years (range, 18 to 80). Stratum specific likelihood ratio (SSLR) analysis determined separate strata for HbA1c and same-day glucose levels that minimized the likelihood of 90-day complications following THA. Each stratum was propensity-score matched based on age, sex, hypertension, heart failure, chronic obstructive pulmonary disease, and obesity to the lowest respective stratum. The risk ratio (RR) with respect to the lowest matched stratum was observed. RESULTS: Our SSLR analysis identified 3 data-driven HbA1c strata (4.5 to 5.9, 6.0 to 6.9, and 7.0+) and two same-day glucose strata (60 to 189 and 190+) that predicted 90-day major complications. For HbA1c, when compared to the lowest strata (4.5 to 5.9), the risk of 90-day major complications sequentially increased as the HbA1c strata increased: 6.0 to 6.9 (RR: 1.21; P = .041), 7+ (RR: 1.82; P < .001). For same-day glucose, when compared to the matched lowest strata (60 to 189), the risk of 90-day major complications was higher for the 190+ strata (RR: 1.5; P < .001). CONCLUSIONS: Our results support the use of multiple HbA1c strata that can be incorporated into preoperative risk-stratification models. Additionally, we identified a single cut-off level of 190 as a maximum target blood glucose level perioperatively.

APA Citation

Rocks, Madeline C.; Zhao, Amy Y.; Liu, Ivan Z.; Agarwal, Amil R.; Harris, Andrew B.; Gu, Alex; Unger, Anthony S.; and Thakkar, Savyasachi C., "The Creation of Data-Driven Preoperative Hemoglobin A1c and Same-Day Glucose Strata to Stratify Complication Risk Following Total Hip Arthroplasty" (2023). GW Authored Works. Paper 3566.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3566

Department

School of Medicine and Health Sciences Student Works