M. Bedi Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA D. M. King, D. A. Hackbarth, J. C. Neilson Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA C. Mendez, B. Slawski Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA J. A. Charlson Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Clin Orthop Relat Res. 2018 Mar;476(3):580-586. doi: 10.1007/s11999.0000000000000056.
Uncontrolled blood glucose impacts key phases of the wound healing process. Various factors have been associated with postoperative wound complications in soft tissue sarcomas; however, the association of postoperative early morning blood glucose with wound complications, if any, remains to be determined. Because blood glucose levels may be modified, understanding whether glucose levels are associated with wound complications has potential therapeutic importance.
QUESTIONS/PURPOSES: The purposes of this study were (1) to evaluate if postoperative early morning blood glucose is associated with the development of wound complications in soft tissue sarcomas; (2) to determine a blood glucose cutoff that may be associated with an increased risk of wound complications; and (3) to evaluate if patients with diabetes have higher postoperative blood glucose and an associated increased risk of wound complications.
From 2000 to 2015, 298 patients with Stage I to III soft tissue sarcomas of the extremity or chest wall were treated with preoperative radiation ± chemotherapy followed by limb-sparing resection. Of those, 191 (64%) patients had demographic, treatment, and postoperative variables and wound outcomes available; these patients' results were retrospectively evaluated. None of the 191 patients were lost to followup. Early morning blood glucose levels on postoperative day (POD) 1 were available in all patients. Wound complications were defined as those resulting in an operative procedure or prolonged wound care for 6 months postresection. Variables that may be associated with wound complications were evaluated using logistic regression for multivariate analysis. Receiver operative curve (ROC) analysis was used to assess the early morning blood glucose level that best was associated postoperative wound complications.
After controlling for potentially relevant confounding variables such as patient comorbidities, tumor size, and location, lower extremity soft tissue sarcomas (p = 0.002, odds ratio [OR], 6.4; 95% confidence interval [CI], 1.97-20.84) and elevated POD 1 early morning blood sugars (p < 0.001; OR, 1.1; 95% CI, 1.04-1.11) were associated with increased wound complications postoperatively. ROC analysis revealed that early morning POD 1 blood glucose of > 127 mg/dL was associated with postoperative wound complications with a sensitivity of 89% (area under the curve 0.898, p < 0.001). Median POD 1 early morning blood glucose in patients without diabetes was 118 mg/dL and 153 mg/dL in patients with diabetes (p = 0.023). However, with the numbers available, there was no increase in wound complications in patients with diabetes compared with those without it.
Our study provides preliminary information suggesting that POD 1 early morning blood glucose in patients with soft tissue sarcomas may be associated with a slightly increased risk of postoperative wound complications. An early morning blood glucose of > 127 mg/dL may be a threshold associated with this outcome. Although patients with diabetes had higher POD 1 early morning blood glucose levels, diabetes itself was not associated with the development of wound complications. We cannot conclude that better glycemic control will reduce wound complications in patients who receive preoperative radiation, but our data suggest this should be further studied in a larger, prospective study.
Level III, therapeutic study.
不受控制的血糖会影响伤口愈合过程的关键阶段。各种因素与软组织肉瘤的术后伤口并发症有关；然而，术后清晨血糖与伤口并发症之间的关系（如果有的话）仍有待确定。由于血糖水平可能会发生变化，了解血糖水平是否与伤口并发症有关具有潜在的治疗意义。
问题/目的：本研究的目的是：(1) 评估术后清晨血糖是否与软组织肉瘤的伤口并发症的发生有关；(2) 确定可能与伤口并发症风险增加相关的血糖切点；(3) 评估糖尿病患者是否有更高的术后血糖和相关的伤口并发症风险增加。
2000 年至 2015 年，298 例肢体或胸壁 I 至 III 期软组织肉瘤患者接受术前放疗加化疗，随后行保肢切除术。其中 191 例（64%）患者具有人口统计学、治疗和术后变量以及伤口结局数据；对这些患者的结果进行了回顾性评估。没有患者失访。所有患者都有术后第 1 天（POD）的清晨血糖水平。伤口并发症定义为导致手术或延长术后 6 个月伤口护理的并发症。使用逻辑回归进行多变量分析，评估与伤口并发症相关的可能变量。接收者操作曲线（ROC）分析用于评估与术后伤口并发症最相关的清晨血糖水平。
在控制了患者合并症、肿瘤大小和位置等潜在混杂变量后，下肢软组织肉瘤（p = 0.002，优势比[OR]，6.4；95%置信区间[CI]，1.97-20.84）和升高的 POD 1 清晨血糖（p < 0.001；OR，1.1；95% CI，1.04-1.11）与术后伤口并发症增加相关。ROC 分析显示，POD 1 清晨血糖 > 127mg/dL 与术后伤口并发症相关，灵敏度为 89%（曲线下面积 0.898，p < 0.001）。无糖尿病患者的 POD 1 清晨中位血糖为 118mg/dL，糖尿病患者为 153mg/dL（p = 0.023）。然而，根据现有的数据，与无糖尿病患者相比，糖尿病患者的伤口并发症并未增加。
我们的研究提供了初步信息，表明软组织肉瘤患者的 POD 1 清晨血糖可能与术后伤口并发症的风险略有增加相关。血糖 > 127mg/dL 可能是与该结果相关的阈值。尽管糖尿病患者的 POD 1 清晨血糖水平较高，但糖尿病本身与伤口并发症的发生无关。我们不能得出结论，术前放疗患者的血糖控制更好会减少伤口并发症，但我们的数据表明，这应该在更大的前瞻性研究中进一步研究。
III 级，治疗研究。
