Department of Orthopaedic Surgery, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ; Department of Orthopaedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, FL.
Department of Orthopaedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, FL; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
J Arthroplasty. 2018 Jul;33(7):2038-2042. doi: 10.1016/j.arth.2018.01.062. Epub 2018 Feb 5.
Patients who have diabetes mellitus (DM) are at an increased risk of postoperative complications following total hip arthroplasty (THA). Therefore, much interest has been paid to perioperative glycemic control. However, no prior studies have evaluated the patient variation of HbA1c levels on costs. Therefore, the purpose of this study was to evaluate the impact of obtaining preoperative HbA1c levels on (1) day of surgery (DOS) cost; (2) subsequent 89-day costs; and (3) global 90-day cost.
A retrospective query of the Humana insurance claims database was performed from 2007 to 2015 for all DM patients undergoing THA. Only patients with HbA1c (%) levels within 3 months before or after the THA were included. Patients were stratified into 6 groups based on HbA1c starting at 5.5% and increasing by 1% increments to 11.5%; one additional group (11.5%-20%) for extreme cases was analyzed. Correlations between HbA1c level and reimbursements for DOS, subsequent 89-day, and global 90-day period were performed.
HbA1c level demonstrated a significant correlation to DOS (correlation coefficient = 0.664), subsequent 89-day (correlation coefficient = 0.789), and global 90-day period (correlation coefficient = 0.747) costs. DOS, 89-day, and global 90-day costs significantly increased with increasing HbA1c levels (P < .0001).
Higher perioperative HbA1c levels increase the DOS, subsequent 89-day, and global 90-day costs of THA. This was expected as these patients require multidisciplinary care, have longer LOS, and develop more complications. Further investigation into postoperative complications based on glycemic control is warranted.
患有糖尿病（DM）的患者在接受全髋关节置换术（THA）后发生术后并发症的风险增加。因此，人们对围手术期血糖控制非常关注。但是，尚无研究评估 HbA1c 水平对患者成本的变化。因此，本研究的目的是评估获得术前 HbA1c 水平对（1）手术当天（DOS）成本；（2）随后 89 天的成本；以及（3）90 天的总成本的影响。
对 2007 年至 2015 年 Humana 保险索赔数据库进行了回顾性查询，以获取所有接受 THA 的 DM 患者。仅包括 HbA1c（%）水平在 THA 前后 3 个月内的患者。根据 HbA1c 从 5.5%开始，每增加 1%递增到 11.5%，将患者分为 6 组；还分析了一个极端情况（11.5%-20%）的额外组。对 HbA1c 水平与 DOS、随后 89 天和 90 天期间的报销之间的相关性进行了分析。
HbA1c 水平与 DOS（相关系数= 0.664）、随后 89 天（相关系数= 0.789）和 90 天期间（相关系数= 0.747）的成本均呈显著相关。DOS、89 天和 90 天的成本随着 HbA1c 水平的升高而显著增加（P <.0001）。
较高的围手术期 HbA1c 水平会增加 THA 的 DOS、随后 89 天和 90 天的成本。这是可以预期的，因为这些患者需要多学科的护理，住院时间更长，并且更容易发生并发症。有必要进一步研究基于血糖控制的术后并发症。
