Department of Orthopedic Surgery, Ochsner Medical Center, New Orleans, Louisiana.
Center for Applied Health Services Research, Ochsner Medical Center, New Orleans, Louisiana.
J Arthroplasty. 2018 Jul;33(7S):S76-S80. doi: 10.1016/j.arth.2018.02.071. Epub 2018 Feb 26.
Diabetic patients undergoing total joint arthroplasty (TJA) with postoperative hyperglycemia >200 mg/dL have increased the risk of prosthetic joint infection (PJI). We investigated the correlation between preoperative hemoglobin A1c (A1c) and postoperative hyperglycemia in diabetic patients undergoing TJA.
A retrospective review of 773 diabetic patients undergoing TJA was conducted. A Youden's J computational analysis determined the A1c where postoperative glucose levels >200 mg/dL were statistically more likely. Patients were then stratified into 3 groups: A1c <7%, A1c 7.0-8.0%, and A1c >8.0%. Outcomes included the highest postoperative in-hospital serum glucose level and PJI.
We determined an A1c >7.45% resulted in a greater chance of postoperative hyperglycemia >200 mg/dL. Average postoperative serum glucose increased with A1c (A1c < 7 = 167 mg/dL, A1c 7.0-8.0 = 240 mg/dL, and A1c > 8 = 276 mg/dL, P < .0001). PJI did not statistically increase with A1c (2.25%, 1.99%, and 4.55%, respectively, P = .4319).
Preoperative hemoglobin A1c levels correlate with postoperative glucose levels. We recommend using an A1c cutoff of 7.45% for patients undergoing TJA and suggest that caution should be exercised in patients with elevated A1c levels undergoing TJA.
接受全关节置换术（TJA）的糖尿病患者术后血糖 >200mg/dL 会增加假体关节感染（PJI）的风险。我们研究了 TJA 术后糖尿病患者术前糖化血红蛋白（A1c）与术后高血糖之间的相关性。
对 773 例接受 TJA 的糖尿病患者进行回顾性分析。通过 Youden's J 计算分析确定 A1c 切点，术后血糖 >200mg/dL 的概率统计上更有可能。然后将患者分为 3 组：A1c <7%、A1c 7.0-8.0%和 A1c >8.0%。结果包括术后住院期间最高血清血糖水平和 PJI。
我们发现 A1c >7.45%会增加术后高血糖 >200mg/dL 的几率。术后平均血清葡萄糖水平随 A1c 升高而升高（A1c <7%=167mg/dL，A1c 7.0-8.0%=240mg/dL，A1c >8%=276mg/dL，P<.0001）。PJI 与 A1c 无统计学相关性（分别为 2.25%、1.99%和 4.55%，P=0.4319）。
术前糖化血红蛋白水平与术后血糖水平相关。我们建议 TJA 患者使用 A1c 切点 7.45%，并建议在 A1c 水平升高的 TJA 患者中应谨慎。
