神经病变和未得到良好控制的糖尿病会增加足踝手术后手术部位感染的几率。
Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery.
机构信息
Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 2100 Jane Street, Pittsburgh, PA 15203. E-mail address for D.K. Wukich:
Phoenix VA Healthcare System, 650 East Indian School Road, Phoenix, AZ 85012.
出版信息
J Bone Joint Surg Am. 2014 May 21;96(10):832-9. doi: 10.2106/JBJS.L.01302.
BACKGROUND
This prospective study was designed to evaluate the frequency of surgical site infection in patients treated with foot and ankle surgery. Our hypothesis was that patients with complications of diabetes are at increased risk for surgical site infection compared with patients without diabetes and patients with diabetes who do not have diabetic complications. Another goal was to compare the association of neuropathy with surgical site infection in both nondiabetic and diabetic patients.
METHODS
Two thousand and sixty consecutive surgical cases were evaluated. Group 1 included nondiabetic patients without neuropathy, Group 2 included nondiabetic patients with neuropathy, Group 3 included patients with diabetes but no diabetic complications, and Group 4 included patients with diabetes who had at least one complication of diabetes.
RESULTS
The surgical site infection rate in this study was 3.1%. Patients with complicated diabetes had a 7.25-fold increased risk of surgical site infection compared with nondiabetic patients without neuropathy and a 3.72-fold increased risk compared with patients with uncomplicated diabetes. Patients with complicated diabetes had a nonsignificant 1.54-fold higher rate of surgical site infection compared with nondiabetic patients with neuropathy. Nondiabetic patients with neuropathy had a significant 4.72-fold increased risk of surgical site infection compared with nondiabetic patients without neuropathy. Despite this, nondiabetic patients with neuropathy did not have a significantly higher rate of surgical site infection than patients with uncomplicated diabetes, and the frequency of surgical site infection in the group with uncomplicated diabetes was not significantly different from that in the nondiabetic patients without neuropathy. Multivariable logistic regression analysis demonstrated that peripheral neuropathy and a hemoglobin A1c of ≥8% were independently associated with surgical site infection.
CONCLUSIONS
Complicated diabetes increases the risk of surgical site infection after foot and ankle surgery. Patients who had diabetes without complications did not have a greater risk of surgical site infection compared with nondiabetic patients without neuropathy. The presence of neuropathy increases the risk of surgical site infection even in patients without diabetes. Poor long-term glycemic control is also associated with an increased risk of surgical site infection.
LEVEL OF EVIDENCE
Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
背景
本前瞻性研究旨在评估足部和踝关节手术后患者的手术部位感染发生率。我们的假设是，与无糖尿病的患者和无糖尿病并发症的糖尿病患者相比，有糖尿病并发症的患者发生手术部位感染的风险更高。另一个目标是比较周围神经病变与非糖尿病和糖尿病患者手术部位感染的关系。
方法
评估了 2060 例连续手术病例。第 1 组包括无周围神经病变的非糖尿病患者，第 2 组包括无周围神经病变的非糖尿病患者，第 3 组包括有糖尿病但无糖尿病并发症的患者，第 4 组包括至少有 1 种糖尿病并发症的糖尿病患者。
结果
本研究中手术部位感染率为 3.1%。患有复杂糖尿病的患者发生手术部位感染的风险是非无周围神经病变的非糖尿病患者的 7.25 倍，是无并发症糖尿病患者的 3.72 倍。患有复杂糖尿病的患者手术部位感染率比无周围神经病变的非糖尿病患者高 1.54 倍，但无统计学意义。有周围神经病变的非糖尿病患者发生手术部位感染的风险比无周围神经病变的非糖尿病患者高 4.72 倍，差异有统计学意义。尽管如此，有周围神经病变的非糖尿病患者的手术部位感染率并不明显高于无并发症的糖尿病患者，且无并发症糖尿病患者的手术部位感染率与无周围神经病变的非糖尿病患者无显著差异。多变量逻辑回归分析表明，周围神经病变和糖化血红蛋白≥8%与手术部位感染独立相关。
结论
复杂糖尿病会增加足部和踝关节手术后手术部位感染的风险。无并发症的糖尿病患者与无周围神经病变的非糖尿病患者相比，手术部位感染的风险没有增加。即使在没有糖尿病的患者中，周围神经病变的存在也会增加手术部位感染的风险。长期血糖控制不佳也与手术部位感染风险增加有关。
证据水平
预后水平 I。有关证据水平的完整描述，请参见作者说明。
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