Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Vanderbilt School of Medicine, Medical Center East-South Tower, Suite 4200, Nashville, TN 37232, USA.
J Bone Joint Surg Am. 2012 Jul 3;94(13):1181-6. doi: 10.2106/JBJS.K.00193.
The impact of perioperative hyperglycemia in orthopaedic surgery is not well defined. We hypothesized that hyperglycemia is an independent risk factor for thirty-day surgical-site infection in orthopaedic trauma patients without a history of diabetes at hospital admission.
Patients eighteen years of age or older with isolated orthopaedic injuries requiring acute operative intervention were studied. Patients with diabetes, injuries to other body systems, a history of corticosteroid use, or admission to the intensive care unit were excluded. Blood glucose values were obtained, and hyperglycemia was defined in two ways. First, patients with two or more blood glucose levels of ≥200 mg/dL were identified. Second, the hyperglycemic index, a validated measure of overall glucose control during hospitalization, was calculated for each patient. A hyperglycemic index of ≥1.76 (equivalent to ≥140 mg/dL) was considered to indicate hyperglycemia. The primary outcome was thirty-day surgical-site infection. Multivariable logistic regression models evaluating the effect of the markers of hyperglycemia, after controlling for open fractures, were constructed.
Seven hundred and ninety patients were identified. There were 268 open fractures (33.9%). Twenty-one thirty-day surgical-site infections (2.7%) were recorded. Age, race, comorbidities, injury severity, and blood transfusion were not associated with the primary outcome. Of the 790 patients, 294 (37.2%) had more than one glucose value of ≥200 mg/dL. This factor was associated with thirty-day surgical-site infection, with thirteen (4.4%) of the 294 patients with that indication of hyperglycemia having a surgical-site infection versus eight (1.6%) of the 496 patients without more than one glucose value of ≥200 mg/dL (p = 0.02). One hundred and thirty-four (17.0%) of the 790 patients had a hyperglycemic index of ≥1.76, and this was also associated was thirty-day surgical-site infection (ten [7.5%] of 134 versus eleven [1.7%] of 656; p < 0.001). Multivariable logistic regression models demonstrated that two or more blood glucose levels of ≥200 mg/dL was a risk factor for thirty-day surgical-site infection (odds ratio [OR]: 2.7, 95% confidence interval [CI]: 1.1 to 6.7) after adjustment for open fractures (OR: 3.2, 95% CI: 1.3 to 7.8). A second model demonstrated that a hyperglycemic index of ≥1.76 was an independent risk factor for surgical-site infection (OR: 4.9, 95% CI: 2.0 to 11.8) after controlling for open fractures (OR: 3.3, 95% CI: 1.4 to 8.3).
Hyperglycemia was an independent risk factor for thirty-day surgical-site infection in orthopaedic trauma patients without a history of diabetes.
骨科手术中围手术期高血糖的影响尚未明确。我们假设在没有糖尿病病史的骨科创伤患者中，高血糖是术后 30 天手术部位感染的独立危险因素。
研究对象为年龄在 18 岁及以上、需要急性手术干预的单纯骨科损伤患者。排除糖尿病患者、其他系统损伤患者、皮质类固醇使用史或入住重症监护病房的患者。采集血糖值，并通过两种方法定义高血糖：一是有两个或更多血糖水平≥200mg/dL 的患者；二是计算每位患者的高血糖指数，这是住院期间整体血糖控制的有效衡量指标。高血糖指数≥1.76（相当于≥140mg/dL）被认为存在高血糖。主要结局是术后 30 天手术部位感染。构建了多变量逻辑回归模型，以评估控制开放性骨折后高血糖标志物的影响。
共纳入 790 例患者，其中开放性骨折 268 例（33.9%）。记录了 21 例术后 30 天手术部位感染（2.7%）。年龄、种族、合并症、损伤严重程度和输血与主要结局无关。在 790 例患者中，294 例（37.2%）有两次或两次以上血糖值≥200mg/dL。该因素与术后 30 天手术部位感染相关，294 例存在该指标高血糖的患者中有 13 例（4.4%）发生手术部位感染，而 496 例血糖值<200mg/dL 的患者中仅有 8 例（1.6%）发生手术部位感染（p=0.02）。134 例（17.0%）患者的高血糖指数≥1.76，也与术后 30 天手术部位感染相关（134 例患者中有 10 例[7.5%]，656 例患者中有 11 例[1.7%]；p<0.001）。多变量逻辑回归模型表明，两次或两次以上血糖值≥200mg/dL 是术后 30 天手术部位感染的危险因素（比值比[OR]：2.7，95%置信区间[CI]：1.1 至 6.7），校正开放性骨折后（OR：3.2，95%CI：1.3 至 7.8）。第二个模型表明，高血糖指数≥1.76 是术后 30 天手术部位感染的独立危险因素（OR：4.9，95%CI：2.0 至 11.8），校正开放性骨折后（OR：3.3，95%CI：1.4 至 8.3）。
在没有糖尿病病史的骨科创伤患者中，高血糖是术后 30 天手术部位感染的独立危险因素。
