Department of Laboratory Medicine, Al Razi Hospital, Ministry of Health, Safat 4235, Kuwait.
Med Princ Pract. 2009;18(6):447-52. doi: 10.1159/000235893. Epub 2009 Sep 30.
To study the relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait.
Patients who underwent surgical orthopedic procedures between 2006 and 2007 were identified to provide demographic and clinical informations including age, gender, type of surgery, length of operation, HbA(1c) values, nature of specimens and species of the isolated pathogens. HbA(1c) <7% was used as the breaking point for diabetic control and occurrence of postoperative complications. Primary outcomes with infectious complications, including urinary tract infection, surgical site infection (SSI), lower respiratory tract infection and sepsis with different isolated pathogens were identified at least 48 h postoperatively.
Of 318 diabetic patients who underwent surgical operations, 90 (28.3%) developed postoperative complications; HbA(1c) <7% was significantly associated with decreased infectious complications with an adjusted odds ratio of 2.51 (95% confidence interval, 1.20-2.89). Regarding types of complications, urinary tract infectious complications were significantly higher among those patients with HbA(1c) > or =7% (p < 0.0001), while other complications (SSI, lower respiratory tract infection and sepsis) showed nonsignificant differences (p > 0.05).
Our study confirmed a close association between preoperative glucose control indicated by HbA(1c) levels <7% and a decreased risk of postoperative infectious complications. Ideally, preoperative blood sugar should be controlled prior to elective surgery. Prophylaxis by antibiotics with preoperative patient preparation, proficient surgical technique and postoperative wound care is recommended for uncontrolled diabetics subjected to surgery.
研究科威特一家骨科医院糖尿病患者术后感染并发症与血糖控制之间的关系。
对 2006 年至 2007 年间接受骨科手术的患者进行了鉴定，以提供包括年龄、性别、手术类型、手术时间、糖化血红蛋白（HbA1c）值、标本性质和分离病原体种类在内的人口统计学和临床信息。HbA1c<7%被用作糖尿病控制和术后并发症发生的分界点。术后至少 48 小时，将感染性并发症（包括尿路感染、手术部位感染、下呼吸道感染和伴有不同分离病原体的败血症）确定为主要结局。
在 318 例接受手术的糖尿病患者中，90 例（28.3%）发生了术后并发症；HbA1c<7%与感染性并发症减少显著相关，调整后的优势比为 2.51（95%置信区间，1.20-2.89）。关于并发症类型，HbA1c≥7%的患者尿路感染并发症明显较高（p<0.0001），而其他并发症（手术部位感染、下呼吸道感染和败血症）无显著差异（p>0.05）。
我们的研究证实了术前 HbA1c 水平<7%所表示的血糖控制与术后感染并发症风险降低之间的密切关联。理想情况下，应在择期手术前控制术前血糖。建议对接受手术的未控制糖尿病患者进行抗生素预防，并在术前进行患者准备、熟练的手术技术和术后伤口护理。
