Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina, U.S.A..
Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Arthroscopy. 2019 May;35(5):1316-1321. doi: 10.1016/j.arthro.2018.11.059. Epub 2019 Apr 9.
To compare complications after shoulder arthroscopy in patients with insulin-dependent diabetes mellitus (IDDM), patients with non-insulin-dependent diabetes mellitus (NIDDM), and nondiabetic patients.
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database for the years 2005 to 2016 was conducted. Logistic regression analyses were used to assess the relation between diabetic status (nondiabetic patients, n = 50,626; NIDDM patients, n = 5,332; and IDDM patients, n = 2,484) and outcomes. Multivariate models were established to adjust for age, sex, body mass index, hypertension, congestive heart failure, chronic obstructive pulmonary disease, smoking status, American Society of Anesthesiologists classification, and functional status.
Patients with IDDM were at a higher risk of medical complications, with an adjusted odds ratio (AOR) of 1.524 (95% confidence interval [CI], 1.082-2.147), including pulmonary complications (AOR, 2.078; 95% CI, 1.089-3.964) and urinary tract infections (AOR, 2.129; 95% CI, 1.027-4.415). Patients with IDDM also had a higher risk of 30-day hospital admission (AOR, 1.581; 95% CI, 1.153-2.169) and 30-day mortality (AOR, 3.821; 95% CI, 1.243-11.750). Conversely, patients with NIDDM had comparable risks of medical and surgical complications, unplanned hospital admission, and death to nondiabetic patients.
Medical complications, 30-day hospital admission, and death after shoulder arthroscopy were more likely in patients with IDDM. These risks diminished among patients with NIDDM, with their risks being comparable with those of nondiabetic patients.
Level III, retrospective comparison study.
比较胰岛素依赖型糖尿病（IDDM）、非胰岛素依赖型糖尿病（NIDDM）和非糖尿病患者肩关节镜术后的并发症。
对 2005 年至 2016 年美国外科医师学会国家手术质量改进计划数据库进行回顾性分析。采用逻辑回归分析评估糖尿病状态（非糖尿病患者，n=50626；NIDDM 患者，n=5332；IDDM 患者，n=2484）与结局之间的关系。建立多变量模型，以调整年龄、性别、体重指数、高血压、充血性心力衰竭、慢性阻塞性肺疾病、吸烟状况、美国麻醉师协会分类和功能状态。
IDDM 患者发生医疗并发症的风险较高，调整后的优势比（AOR）为 1.524（95%置信区间[CI]，1.082-2.147），包括肺部并发症（AOR，2.078；95%CI，1.089-3.964）和尿路感染（AOR，2.129；95%CI，1.027-4.415）。IDDM 患者 30 天住院（AOR，1.581；95%CI，1.153-2.169）和 30 天死亡率（AOR，3.821；95%CI，1.243-11.750）的风险也较高。相反，NIDDM 患者的医疗和手术并发症、非计划性住院和死亡风险与非糖尿病患者相当。
IDDM 患者肩关节镜术后发生医疗并发症、30 天住院和死亡的风险更高。NIDDM 患者的这些风险降低，与非糖尿病患者的风险相当。
III 级，回顾性比较研究。
