Association between haemoglobin A1C/albumin ratio and deep postoperative infection after total joint arthroplasty: a single centre study

Amit K. Srivastava; Neha Gupta; Vivek Kumar Chimmpa; Rudra Pratap Singh; Aman Srivastava

doi:10.18203/issn.2455-4510.IntJResOrthop20253415

Authors

Amit K. Srivastava Department of Orthopaedics, K. D. M. C. H and R. C. Mathura, U.P., India
Neha Gupta Department of Internal Medicine, Santosh Medical College, Ghaziabad, U. P., India
Vivek Kumar Chimmpa Max Superspecialty Hospital, Patparganj, New Delhi, India
Rudra Pratap Singh MLN medical College, Allahabad, U.P., India
Aman Srivastava Department of Orthopaedics, UPUMS, Safai, U.P., India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253415

Keywords:

HbA1c/albumin ratio, Periprosthetic infection, Risk factors, Total joint arthroplasty, Diabetes mellitus

Abstract

Background: Till the time in modern practice in a centre where total joint arthroplasty (TJA) including hip and knee mainly is being done in high volume (>100 TJA in a month), there are no guiding parameters to estimate the risk of developing periprosthetic infections in diabetes mellitus. This study aims to compare the risks of periprosthetic infection in patients undergoing total joint arthroplasty with diabetes mellitus (DM) and to investigate the predictive significance of the HbA1c/albumin ratio, so that a guideline can be given to avoid such dreaded complication in diabetic patients.

Methods: Between January 2019 and January 2023, 490 patients who underwent total joint arthroplasty were analysed.187 diabetic patients were included in the study. 28 of them had periprosthetic infection. Six risk factors (Hba1c/albumin, age, BMI, ASA, length of hospital stay, and surgical duration) were analysed.

Results: The rate of HbA1c/albumin was 13.9 times higher than the patients with ≤2.35 cut off value. (Hba1c/albumin ratio (odds ratio (OR)=13.9, 95% CI: 3.18-67.1, p: 0.01). BMI (OR=1.6, 95% CI: 1.168-2.199, p<0.003), DM (OR=0.365, 95% CI: 0.135-0.987, p: 0.04) and glucose (OR=1.016, 95% CI: 1.004-1.029, p: 0.011) were risk factures for periprosthetic infection. Albumin (OR=0.503, 95% CI: 0.109-2.314, p: 0.378) was not found to be a significant risk factor for periprosthetic infection.

Conclusions: In view of our observation in present study we analysed that the HbA1c/albumin ratio has a reliable prognostic indicator than other risk factors in determining the chances of catching the risk of periprosthetic infection after TJA. HbA1c/albumin ratio is a cost effective and easily available parameter to many centres without posing much cost burden. Patients with an HbA1c/albumin cut-off ratio above 2.35 mg/dl in TJA better should avoided from surgery and should be followed more closely for the risk of periprosthetic infection after TJA.

Metrics

Metrics Loading ...

References

Yigit Ş, Akar MS, Şahin MA, Arslan H. Periprosthetic infection risks and predictive value of C-reactive protein/albumin ratio for total joint arthroplasty. Acta Biomed. 2021;92:324.

Muller LM, Gorter KJ, Hak E, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005;41(3):281-8. DOI: https://doi.org/10.1086/431587

Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas CS. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol. 2001;22(10):607-12. DOI: https://doi.org/10.1086/501830

Brenner RE, Riemenschneider B, Blum W. Defective stimulation of proliferation and collagen biosynthesis of human bone cells by serum from diabetic patients. Acta Endocrinol (Copenh). 1992;127(6):509-14. DOI: https://doi.org/10.1530/acta.0.1270509

Robertson HD, Polk HC. The mechanism of infection in patients with diabetes mellitus: a review of leukocyte malfunction. Surgery. 1974;75(1):123-8.

Lambertz OC, Yagdiran A, Wallscheid F, Eysel P, Jung N. Periprosthetic infection in joint replacement. Dtsch Arztebl Int. 2017;114:347-53.

Goh SL, De Silva RP, Dhital K, Gett RM. Is low serum albumin associated with postoperative complications in patient’s under-going oesophagectomy for oesophageal malignancies. Interact Cardiovasc Thorac Surg. 2015;20:107-13. DOI: https://doi.org/10.1093/icvts/ivu324

Bolognesi MP, Marchant MH, Viens NA, Cook C,Pietrobon R, Thomas PV. The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty 2008; 23: 92-98. DOI: https://doi.org/10.1016/j.arth.2008.05.012

Rizvi AA, Chiloag SA, Chiloag KJ. Peri-operative management of diabetes in hyperglycemia in patients undergoing orthopaedic surgery. J AAOS. 2010;18:426-35. DOI: https://doi.org/10.5435/00124635-201007000-00005

Parvizi J, Gehrke T. International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29:1331. DOI: https://doi.org/10.1016/j.arth.2014.03.009

Arampatzis S, Frauchiger B, Fiedler GM, Leichtle AB, Buhl D, Schwarz C, Georg CF, Heinz Z, Aristomenis KE, Gregor L. Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission. Am J Med. 2012;125:1125-7. DOI: https://doi.org/10.1016/j.amjmed.2012.04.041

Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27:302-45. DOI: https://doi.org/10.1128/CMR.00111-13

Momohara S, Kawakami K, Iwamoto T, Yono K, Sakuma Y, Hiroshima R, Imamura H, Masuda I, Tokita A, Ikari K. Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. Mod Rheumatol. 2011;21:469-75. DOI: https://doi.org/10.1007/s10165-011-0423-x

Jämsen E, Nevalainen P, Eskelinen A, Kaisa H, Jarkko K, Teemu M. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Jt Surg Am. 2012;94:101. DOI: https://doi.org/10.2106/JBJS.J.01935

Han HS, Kang SB. Relations between long-term glycemic control and postoperative wound and infectious complications after total knee arthroplasty in type 2 diabetics. Clin Orthop Surg. 2013;5:118-23. DOI: https://doi.org/10.4055/cios.2013.5.2.118

Iwata M, Kuzuya M, Kitagawa Y, Iguchi A. Prognostic value of serum albumin combined with serum C-reactive protein levels in older hospitalized patients: continuing importance of serum albumin. Aging Clin Exp Res. 2006;18:307-11. DOI: https://doi.org/10.1007/BF03324664

Greene KA, Wilde AH, Stulberg BN. Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications. J Arthroplasty. 1991;6:321-5. DOI: https://doi.org/10.1016/S0883-5403(06)80183-X

Huang R, Greenky M, Kerr GJ, Matthew SA, Javad P. The effect of malnutrition on patients undergoing elective joint arthroplasty. J Arthroplasty. 2013;28:21-4. DOI: https://doi.org/10.1016/j.arth.2013.05.038

Si HB, Zeng Y, Shen B, Jing Y, Zhou Z, Kang P, Pei F. The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc. 2015;23:1824-32. DOI: https://doi.org/10.1007/s00167-014-3301-1

Claus A, Asche G, Brade J, Schwenkglenks MB, Horchler H, Müller JF, Schumm W, Weise K, Scharf HP. Risk profiling of postoperative complications in 17,644 total knee replacement. Der Unfallchirurg. 2006;109:5-12. DOI: https://doi.org/10.1007/s00113-005-0992-2

Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty. J Bone Joint Surg Am. 2013;95:775-82. DOI: https://doi.org/10.2106/JBJS.L.00211