From the Department of Orthopaedic Surgery, the University of Virginia Health System (Dr. Cancienne), and the Department of Orthopaedic Surgery, the University of Virginia (Dr. Brockmeier and Dr. Werner) Charlottesville, VA.
J Am Acad Orthop Surg. 2018 Jun 1;26(11):e238-e245. doi: 10.5435/JAAOS-D-16-00784.
Although diabetes mellitus (DM) has been established as a risk factor for infection after lower extremity arthroplasty, no association has been reported with shoulder arthroplasty.
We queried a national database for patients with DM who underwent primary shoulder arthroplasty. We identified perioperative hemoglobin A1c (HbA1c) levels and assessed the incidence of wound complications within 6 months and deep infection that required surgical intervention within 1 year for each HbA1c level. We performed a receiver operating characteristic analysis to determine a threshold value of HbA1c.
Patients with DM had markedly higher rates of wound complications (1.4% versus 0.9%; odds ratio, 1.22; P = 0.028) and deep infection (0.7% versus 0.4%; odds ratio, 1.47; P = 0.001). The rates of wound complications (P = 0.0008) and deep postoperative infection (P = 0.002) increased markedly as the perioperative HbA1c level increased. Receiver operating characteristic analysis demonstrated an inflection point at an HbA1c level of 8.0 mg/dL (P = 0.017; sensitivity, 50%; specificity, 75%).
The risk of wound complications and deep postoperative infection in patients with DM increases as the perioperative HbA1c level increases. An HbA1c level >8.0 mg/dL could serve as a threshold for a markedly increased risk of infection.
Therapeutic level III, case-control study, treatment study.
尽管糖尿病（DM）已被确定为下肢关节置换术后感染的危险因素，但尚未报道其与肩部关节置换术有关。
我们在全国数据库中查询了接受初次肩部关节置换术的糖尿病患者。我们确定了围手术期糖化血红蛋白（HbA1c）水平，并评估了每个 HbA1c 水平下 6 个月内伤口并发症的发生率和 1 年内需要手术干预的深部感染发生率。我们进行了受试者工作特征分析，以确定 HbA1c 的阈值。
患有糖尿病的患者伤口并发症发生率明显更高（1.4%比 0.9%；比值比，1.22；P=0.028）和深部感染（0.7%比 0.4%；比值比，1.47；P=0.001）。随着围手术期 HbA1c 水平的升高，伤口并发症（P=0.0008）和深部术后感染（P=0.002）的发生率明显增加。受试者工作特征分析显示，HbA1c 水平为 8.0 mg/dL 时出现拐点（P=0.017；敏感性，50%；特异性，75%）。
随着围手术期 HbA1c 水平的升高，糖尿病患者的伤口并发症和深部术后感染风险增加。HbA1c 水平>8.0 mg/dL 可能成为感染风险明显增加的阈值。
治疗性 III 级，病例对照研究，治疗研究。
