The Association of Perioperative Glycemic Control With Adverse Outcomes Within 6 Months After Arthroscopic Rotator Cuff Repair.

Abstract

To determine the association between glycemic control and adverse events after arthroscopic rotator cuff repair (RCR). Patients with a diagnosis of diabetes mellitus who underwent arthroscopic RCR and had a hemoglobin A_1c (HbA_1c) level determined within 3 months before or after surgery were identified in a national database and stratified by HbA_1c level. The incidence of postoperative infection within 6 months was determined using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. A receiver operating characteristic (ROC) curve analysis was performed to determine whether a threshold HbA_1c level existed above which the risk of infection, revision rotator cuff surgery, and lysis of adhesions (LOA)-manipulation under anesthesia (MUA) after arthroscopic RCR was significantly increased. This threshold was then tested using a logistic regression analysis. The study included 3,740 patients with an infection rate ranging from a low of 0.29% to a high of 1.14% after RCR. The inflection point of the ROC curve for infection corresponded to an HbA_1c level between 7.0 and 8.0 mg/dL (P = .035; area under the curve, 0.648; specificity, 61%; sensitivity, 59%). We then used 8.0 mg/dL as a threshold to test for adverse outcomes. We found a significant difference in infection rates for patients with levels below versus above the threshold (0.30% vs 0.84%; OR, 2.0; 95% confidence interval, 1.2-3.4; P = .014) but no difference in revision rates (P = .240) or LOA-MUA (P = .650) in patients with levels above versus below the threshold. The risk of infection after RCR in patients with diabetes mellitus increases as the perioperative HbA_1c level increases and, although statistically significant, remains low. ROC curve analysis determined that a perioperative HbA_1c level above 8.0 mg/dL could serve as a threshold level; however, the area under the curve and low sensitivity reflected the poor utility of this test as an independent predictor. This study did not find an association between increased perioperative HbA_1c levels and rates of revision rotator cuff surgery or LOA-MUA after RCR. Level III, retrospective cohort study.