Blankush Joseph M, Leitman I Michael, Soleiman Aron, Tran Trung
Department of Surgery, Mount Sinai Beth Israel, United States; Department of Surgery, Icahn School of Medicine at Mount Sinai, United States.
Ann Med Surg (Lond). 2016 Aug 9;10:77-82. doi: 10.1016/j.amsu.2016.07.025. eCollection 2016 Sep.
A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infections. Such infections increase morbidity, length of stay, and overall cost. This study evaluates the correlation between elevated pre-operative glycosylated hemoglobin (HbA1c) and post-operative infections.
Adult patients undergoing non-emergent procedures across all surgical subspecialties from January 2010 to July 2014 had a preoperative HbA1c measured as part of their routine pre-surgical assessment. 2200 patient charts (1100 < 6.5% HbA1c and1100 ≥ 6.5% HbA1c) were reviewed for evidence of post-operative infection (superficial surgical site infection, deep wound/surgical space abscess, pneumonia, and/or urinary tract infection as defined by Centers for Disease Control criteria) within 30 days of surgery.
Patients with HbA1c < 6.5% and those with HbA1c ≥ 6.5% showed no statistically significant difference in overall infection rate (3.8% in the HbA1c < 6.5% group vs. 4.5% in the HbA1c ≥ 6.5% group, p = 0.39). Both linear regression and multivariate analysis did not identify HbA1c as an individual predictor of infection. Elevated HbA1c was, however, predictive of significantly increased risk of post-operative infection when associated with increased age (≥81 years of age) or dirty wounds.
The risk factors of post-operative infection are multiple and likely synergistic. While pre-operative HbA1c level is not independently associated with risk of post-operative infection, there are scenarios and patient subgroups where pre-operative HbA1c is useful in predicting an increased risk of infectious complications in the post-operative period.
葡萄糖代谢受损的慢性状态会影响免疫系统的多个组成部分，可能导致术后感染发生率增加。此类感染会增加发病率、住院时间和总体费用。本研究评估术前糖化血红蛋白（HbA1c）升高与术后感染之间的相关性。
2010年1月至2014年7月期间，所有外科亚专业接受非急诊手术的成年患者，其术前HbA1c作为常规术前评估的一部分进行测量。回顾了2200份患者病历（1100份HbA1c<6.5%，1100份HbA1c≥6.5%），以寻找术后30天内发生术后感染（根据疾病控制中心标准定义的浅表手术部位感染、深部伤口/手术间隙脓肿、肺炎和/或尿路感染）的证据。
HbA1c<6.5%的患者和HbA1c≥6.5%的患者在总体感染率上无统计学显著差异（HbA1c<6.5%组为3.8%，HbA1c≥6.5%组为4.5%，p=0.39）。线性回归和多变量分析均未将HbA1c确定为感染的个体预测因素。然而，当HbA1c升高与年龄增加（≥81岁）或伤口污染相关时，可预测术后感染风险显著增加。
术后感染的危险因素是多方面的，且可能具有协同作用。虽然术前HbA1c水平与术后感染风险无独立相关性，但在某些情况下和患者亚组中，术前HbA1c有助于预测术后感染并发症风险增加。
