Department of Preventive Medicine, Hospital la Paz, Madrid, Spain.
Preventive Medicine and Public Health Unit, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
J Arthroplasty. 2017 Dec;32(12):3729-3734.e2. doi: 10.1016/j.arth.2017.06.038. Epub 2017 Jul 5.
We aimed to compare in-hospital postoperative complications (IHPC) and in-hospital mortality between patients with and without type 2 diabetes mellitus (T2DM) undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
We analyzed data from the Spanish National Hospital Discharge Database, 2010-2014. We selected patients who had undergone THA (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 81.51) and TKA (code 81.54). Diabetic patients with THA and TKA were matched by year, age, sex, and the comorbidities included in the modified Elixhauser Comorbidity Index with a nondiabetic patient.
We identified 115,234 THA patients and 195,355 TKA patients, 12.4% and 15.6% with T2DM, respectively. We matched 10,777 and 26,640 pairs of diabetic and nondiabetic patients. In T2DM patients who had undergone THA, the incidence of urinary tract infection was higher than in nondiabetic patients (1.50% vs 1.09%, P = .007), as was that of "any IHPC" (9.68% vs 8.98%, P = .038). In patients who had undergone TKA, the incidence of postoperative anemia was significantly higher in diabetic patients (4.90% vs 4.53, P = .040), as was that of urinary tract infection (0.80% vs 0.53%, P = .025) and "any IHPC" (7.30% vs 6.76%, P = .014). In both procedures, mean length of hospital stay was significantly higher in diabetic patients; for TKA, in-hospital mortality was higher in diabetic patients (0.09% vs 0.02%, P = .002). Previous comorbidities, age, and obesity predict a higher incidence of IHPC among diabetic patients.
This study confirms the higher risk of IHPC among T2DM patients after joint arthroplasty. IHPC may result in a higher risk of mortality in patients undergoing TKA.
我们旨在比较接受初次全髋关节置换术（THA）和全膝关节置换术（TKA）的合并 2 型糖尿病（T2DM）与未合并 T2DM 的患者的院内术后并发症（IHPC）和院内死亡率。
我们分析了 2010 年至 2014 年西班牙国家住院患者数据库的数据。我们选择了接受 THA（国际疾病分类，第 9 修订版，临床修正 [ICD-9-CM] 编码 81.51）和 TKA（编码 81.54）的患者。将 T2DM 患者与 THA 和 TKA 相匹配，根据年份、年龄、性别以及改良 Elixhauser 合并症指数中包含的合并症进行匹配，与非糖尿病患者相匹配。
我们确定了 115234 例 THA 患者和 195355 例 TKA 患者，其中分别有 12.4%和 15.6%患有 T2DM。我们匹配了 10777 例和 26640 对糖尿病和非糖尿病患者。在接受 THA 的 T2DM 患者中，尿路感染的发生率高于非糖尿病患者（1.50% vs 1.09%，P =.007），“任何 IHPC”的发生率也高于非糖尿病患者（9.68% vs 8.98%，P =.038）。在接受 TKA 的患者中，术后贫血的发生率在糖尿病患者中显著更高（4.90% vs 4.53%，P =.040），尿路感染（0.80% vs 0.53%，P =.025）和“任何 IHPC”（7.30% vs 6.76%，P =.014）的发生率也更高。在这两种手术中，糖尿病患者的平均住院时间明显更长；对于 TKA，糖尿病患者的院内死亡率更高（0.09% vs 0.02%，P =.002）。既往合并症、年龄和肥胖症预测糖尿病患者 IHPC 的发生率更高。
本研究证实，T2DM 患者在接受关节置换术后 IHPC 的风险更高。IHPC 可能导致接受 TKA 的患者的死亡率更高。
