Maradit Kremers Hilal, Lewallen Laura W, Mabry Tad M, Berry Daniel J, Berbari Elie F, Osmon Douglas R
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2015 Mar;30(3):439-43. doi: 10.1016/j.arth.2014.10.009. Epub 2014 Oct 15.
Diabetes mellitus is an established risk factor for infections but evidence is conflicting to what extent perioperative hyperglycemia, glycemic control and treatment around the time of surgery modify the risk of prosthetic joint infections (PJIs). In a cohort of 20,171 total hip and knee arthroplasty procedures, we observed a significantly higher risk of PJIs among patients with a diagnosis of diabetes mellitus (hazard ratio [HR] 1.55, 95% CI 1.11, 2.16), patients using diabetes medications (HR 1.56, 95% CI 1.08, 2.25) and patients with perioperative hyperglycemia (HR 1.59, 95% CI 1.07, 2.35), but the effects were attenuated after adjusting for body mass index, type of surgery, ASA score and operative time. Although data were limited, there was no association between hemoglobin A1c values and PJIs.
糖尿病是公认的感染危险因素，但围手术期高血糖、血糖控制及手术前后的治疗在多大程度上会改变人工关节感染（PJI）的风险，相关证据存在矛盾。在一项包含20171例全髋关节和膝关节置换手术的队列研究中，我们观察到，诊断为糖尿病的患者发生PJI的风险显著更高（风险比[HR] 1.55，95%置信区间[CI] 1.11，2.16），使用糖尿病药物的患者（HR 1.56，95% CI 1.08，2.25）以及围手术期高血糖患者（HR 1.59，95% CI 1.07，2.35）发生PJI的风险也显著更高，但在对体重指数、手术类型、美国麻醉医师协会（ASA）评分和手术时间进行校正后，这些影响有所减弱。尽管数据有限，但糖化血红蛋白值与PJI之间并无关联。
