Endocrinology Division, Phoenix VA Health Care System, 650 E. Indian School Road, Phoenix, AZ 85012, USA.
Endocrinology Division, Phoenix VA Health Care System, 650 E. Indian School Road, Phoenix, AZ 85012, USA; University of Arizona College of Medicine-Phoenix, 550 E. Van Buren St., Phoenix, AZ 85004, USA.
J Diabetes Complications. 2017 Dec;31(12):1710-1718. doi: 10.1016/j.jdiacomp.2017.08.016. Epub 2017 Sep 7.
Patients with diabetes mellitus are known to have a high risk of postoperative complications, including infections, impaired wound healing, cardiovascular events, venous thromboembolism, and mortality. Because hyperglycemia has been thought to mediate this risk, there is a clinical propensity for improving glycemic control, as assessed by hemoglobin A1c (HbA1c) level, prior to proceeding with elective surgery, particularly joint replacement surgery. However, it is not established whether chronic poor glycemic control, indicated by elevated HbA1c levels, predicts increased risk of postoperative complications. The benefit of improving glycemic control must be weighed against risks of delaying necessary elective surgery, such as joint replacement surgery, which risks may include negative impact on long-term glycemic control. Thus, we review the current evidence to determine the relationship between HbA1c and postoperative surgical risk, especially on joint replacement surgery.
患有糖尿病的患者已知具有高术后并发症风险，包括感染、伤口愈合不良、心血管事件、静脉血栓栓塞和死亡率。由于高血糖被认为介导了这种风险，因此在进行择期手术（尤其是关节置换手术）之前，临床倾向于改善血糖控制，通过糖化血红蛋白 (HbA1c) 水平进行评估。然而，HbA1c 水平升高表明慢性血糖控制不佳是否预示着术后并发症风险增加尚不确定。改善血糖控制的益处必须与延迟必要的择期手术（如关节置换手术）的风险相权衡，这些风险可能包括对长期血糖控制产生负面影响。因此，我们回顾了目前的证据，以确定 HbA1c 与术后手术风险之间的关系，尤其是在关节置换手术方面。
