Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
J Bone Joint Surg Am. 2018 Jul 5;100(13):1110-1117. doi: 10.2106/JBJS.17.00798.
Increased glucose variability during hospitalization has been associated with a longer length of stay in the hospital and a higher mortality rate following non-orthopaedic surgical procedures. Our aim was to investigate the association between glucose variability and postoperative complications following total joint arthroplasty.
We analyzed data on 21,487 patients who had undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a single center from 2001 to 2017. Patients with a minimum of 2 postoperative glucose values per day or >3 values overall were included in the study. Glucose variability was assessed using a coefficient of variation. Adverse outcomes included an increased length of stay in the hospital, 90-day mortality, reoperations, periprosthetic joint infection, and surgical site infection. Periprosthetic joint infection was defined using the Musculoskeletal Infection Society criteria.
The final cohort included 2,360 patients who had undergone THA and 2,698 who had undergone TKA; 1,007 (19.9%) had diabetes. Higher glycemic variability was associated with an increased length of stay, 90-day mortality, periprosthetic joint infection, and surgical site infection. Adjusted analysis indicated that for every 10-percentage-point increase in the coefficient of variation, the length of stay increased by 6.1% (95% confidence interval [CI], 5.1% to 7.2%; p < 0.001), the risk of mortality increased by 26% (odds ratio [OR] = 1.26, 95% CI = 0.98 to 1.61; p = 0.07), and the risks of periprosthetic joint infection and surgical site infection increased by 20% (OR = 1.20, 95% CI = 1.02 to 1.41; p = 0.03) and 14% (OR = 1.14, 95% CI = 1.00 to 1.31; p = 0.06), respectively. These associations were independent of the year of surgery, age, body mass index, Elixhauser comorbidity index, diagnosis of diabetes, in-hospital use of insulin or steroids, and mean glucose values during hospitalization.
Higher glucose variability in the postoperative period is associated with increased rates of surgical site and periprosthetic joint infections and may be a useful predictor of the risk of mortality following THA and TKA. Efforts should be made to control the glucose variability in the early postoperative period, and future studies should examine the role of continuous glucose monitoring in a subset of patients with high glucose fluctuations.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
住院期间血糖变异性增加与非骨科手术后住院时间延长和死亡率升高有关。我们的目的是研究全关节置换术后血糖变异性与术后并发症之间的关系。
我们分析了 2001 年至 2017 年在一家中心接受全髋关节置换术（THA）或全膝关节置换术（TKA）的 21487 例患者的数据。至少有 2 个术后血糖值/天或总共有>3 个值的患者被纳入研究。使用变异系数评估血糖变异性。不良结局包括住院时间延长、90 天死亡率、再次手术、假体周围关节感染和手术部位感染。假体周围关节感染采用肌肉骨骼感染协会标准定义。
最终队列包括 2360 例接受 THA 和 2698 例接受 TKA 的患者，其中 1007 例（19.9%）患有糖尿病。较高的血糖变异性与住院时间延长、90 天死亡率、假体周围关节感染和手术部位感染有关。调整分析表明，变异系数每增加 10 个百分点，住院时间延长 6.1%（95%置信区间[CI]：5.1%至 7.2%；p<0.001），死亡率风险增加 26%（比值比[OR] = 1.26，95%CI = 0.98 至 1.61；p = 0.07），假体周围关节感染和手术部位感染的风险分别增加 20%（OR = 1.20，95%CI = 1.02 至 1.41；p = 0.03）和 14%（OR = 1.14，95%CI = 1.00 至 1.31；p = 0.06）。这些关联独立于手术年份、年龄、体重指数、Elixhauser 合并症指数、糖尿病诊断、住院期间使用胰岛素或类固醇以及住院期间的平均血糖值。
术后血糖变异性增加与手术部位和假体周围关节感染的发生率增加有关，可能是 THA 和 TKA 后死亡率的有用预测指标。应努力控制术后早期的血糖变异性，未来的研究应检查连续血糖监测在高血糖波动患者亚组中的作用。
预后 IV 级。有关证据水平的完整描述，请参阅作者说明。
