Preoperative fructosamine is comparable to HbA1c as a short-term glycemic marker for predicting postoperative complications in orthopaedic surgery: A systematic review and meta-analysis

Objective This study systematically evaluates the predictive value of preoperative glycaemic biomarkers, including fructosamine, compared with HbA1c and glycated albumin. Methods The databases of PubMed, Embase, and Scopus were searched from inception to September 2025 for studies that assessed preoperative fructosamine levels and postoperative complications in orthopaedic patients. Cohort studies reporting infections, wound complications, readmissions, or reoperations were included. Data extraction and quality assessment were performed independently. A random-effects meta-analysis was used to pool risk estimates, with heterogeneity quantified using the I 2 statistic. Results Seven cohort studies (N = 5217) met the inclusion criteria. Elevated preoperative fructosamine (≈292–293 μmol/L for arthroplasty; ≈238 μmol/L for foot/ankle surgery) was consistently associated with a higher risk of postoperative infection and complications (pooled RR 7.20; 95% CI 1.49–34.91). HbA1c demonstrated a smaller, less consistent effect (pooled RR 2.36; 95% CI 1.04–5.34). Direct comparisons between high fructosamine and high HbA1c cohorts revealed no statistically significant difference, although fructosamine more accurately reflected short-term glycemic status. Conclusions Preoperative fructosamine is a robust short-term glycaemic biomarker that frequently outperforms HbA1c in predicting postoperative infectious complications in arthroplasty and other orthopaedic surgery. Standardised cut-offs, multicenter validation, and interventional trials are needed to define its role in perioperative risk stratification.