Hwang Ji Sup, Kim Seok Jin, Bamne Ankur B, Na Young Gon, Kim Tae Kyun
Seoul National University College of Medicine, Seoul, Republic of Korea.
Clin Orthop Relat Res. 2015 May;473(5):1726-31. doi: 10.1007/s11999-014-4056-1. Epub 2014 Nov 18.
Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated.
QUESTIONS/PURPOSES: We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA.
Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA1c), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA1c level was 7%, the range was 5% to 11.3%.
There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA1c and PPG2 levels (R = 0.502, p < 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval [CI], 1.6-23.4; p = 0.008) and FBG 200 mg/dL or higher (OR, 9.2; 95% CI, 2.2-38.2; p = 0.038) were associated with superficial surgical site infection after TKA.
In general, there is a positive correlation among the various available glycemic markers among patients with diabetes undergoing TKA, and patients undergoing surgery with HbA1c ≥ 8 and/or FBG ≥ 200 mg/dL were associated with superficial surgical site infection. These findings should be considered in patient selection and preoperative counseling for patients with diabetes undergoing TKA.
Level III, prognostic study.
糖尿病患者全膝关节置换术（TKA）后感染和伤口并发症的风险增加。尚未阐明用于识别TKA后有并发症风险患者的血糖标志物。
问题/目的：我们旨在确定四种常用血糖标志物之间的相关性，并确定与糖尿病患者TKA术后手术部位感染和术后伤口并发症发生最密切相关的血糖标志物。
我们的回顾性研究纳入了462例糖尿病患者，共进行了714次TKA手术。作为我们中心糖尿病患者医疗许可计划和既定临床路径的一部分，收集了所有患者的血糖标志物血液水平，包括术前空腹血糖（FBG）、餐后血糖（PPG2）、糖化血红蛋白（HbA1c）以及术后第2、5和14天随机血糖检测结果。93%（495例中的462例）的患者有完整的随访资料。评估了标志物之间的相关性。使用相关临界值的多变量回归分析来分析标志物与患者并发症发生之间的关联。我们将以下任何一种情况视为可能与糖尿病相关的并发症，并将这些情况视为研究终点：手术部位感染（浅表和深部）和伤口并发症（引流、关节积血、皮肤坏死和裂开）。在研究期间，对于糖尿病患者在进行关节置换术前需要达到何种血糖控制水平没有固定标准，所有血糖标志物的水平范围都很广；例如，虽然平均HbA1c水平为7%，但范围为5%至11.
