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Hemoglobin A1c Tests That Orthopedic Surgeons Should Think About

Hemoglobin A1c is a test that measures the amount of glucose attached to the hemoglobin. The test tells us the average level of blood sugar (glucose) of the patient over the last 2-3 months. The normal range of Hemoglobin A1c is between 4% and 5.6%. When the level is 6.5% or higher, this indicates diabetes.

The goal of treatment is to make sure that the patient with diabetes has Hemoglobin A1c less than 7%. The higher the level of Hemoglobin A1c, the higher the risk of developing complications. People should have the test done every three months to check and see that their blood sugar is under control. At minimum, the Hemoglobin A1c test should be done twice per year. HA1c is a better way of measurement that is used to track the progress of diabetes than a blood sugar test. The blood sugar test does not give the big picture. A decrease of 1% in Hemoglobin A1c decreases the risk of complication by almost 37%. Glycated hemoglobin decreases the oxygen carrying capacity and limits the tissue oxygen delivery. In diabetics, the glycated hemoglobin limits delivery of oxygen to the tissues. The physician should be alert of surgical wound complications in patients with a high hemoglobin A1c level. If the condition of the patient is acute or if it is an emergency, we have to do surgery. If the condition is elective such as with carpal tunnel syndrome, then surgery can wait. Don’t rush surgery. We need to improve the Hemoglobin A1c level. If the patient has poor glycemic control, then you probably do not want to perform elective surgery on the patient because the high blood sugar level is linked to increase wound complications after surgery. The higher the preoperative Hemoglobin A1c level, the more there is a risk factor for surgical site of infection. Joint replacement surgery, for example, is delayed until the Hemoglobin A1c levels are less than 7%. Hemoglobin A1c above 7.5 increases the risk of deep post-operative infection following lumbar decompression.

Nabil Ebraheim, MD

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