Uppal Celina, Blanshard Andrew, Ahluwalia Rupa, Dhatariya Ketan
Department of Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
Diabetes Ther. 2019 Oct;10(5):1959-1967. doi: 10.1007/s13300-019-00688-x. Epub 2019 Aug 29.
Diabetes mellitus (DM) is present in 10-15% of the surgical population. It is a known risk factor for adverse postoperative outcomes. UK perioperative guidance recommends optimizing glycemic control preoperatively, aiming for a target glycated hemoglobin (HbA) of < 69 mmol/mol. However, real-world compliance with this guidance remains unknown. The aim of our study was to determine how many patients with DM undergoing elective orthopedic and vascular surgery had a preoperative HbA of < 69 mmol/mol. We also reviewed the surgical reasons for non-concordance with the recommended preoperative HbA target.
This was a retrospective observational study of 1000 consecutive patients who had been referred for elective vascular and orthopedic surgery at a large tertiary center. Data were collected on these patients, both those with and without DM, between January 2016 and February 2017. Electronic databases were used to collect information on the patients' preoperative HbA concentration and to determine whether there was a resulting delay in surgery when the preoperative HbA target of < 69 mmol/mol was exceeded.
Of the 1000 patients referred for surgery (500 orthopedic and 500 vascular patients) included in the study, 201 (20%) had diabetes. Among these 201 people with DM, 155 (77%) had a preoperative HbA < 69 mmol/mol. Among the 46 people with DM whose HbA exceeded the recommended target, 41 were operated on despite the high HbA level, and only five had their surgery deferred or canceled due to suboptimal preoperative glycemic control.
Our data shows that the majority (77% ) of people undergoing elective vascular and orthopedic surgery were able to achieve a target HbA of < 69 mmol/mol. The current preoperative guidance is therefore achievable in a real-life setting. However, as is stated in the national guidance, this target should only be used where it is safe to do so and a degree of clinical discretion is necessary.
糖尿病（DM）在10%至15%的外科手术患者中存在。它是术后不良结局的已知风险因素。英国围手术期指南建议术前优化血糖控制，目标糖化血红蛋白（HbA）<69 mmol/mol。然而，实际中对该指南的遵循情况尚不清楚。我们研究的目的是确定接受择期骨科和血管手术的糖尿病患者中有多少术前HbA<69 mmol/mol。我们还回顾了未达到推荐术前HbA目标的手术原因。
这是一项对一家大型三级中心连续1000例接受择期血管和骨科手术患者的回顾性观察研究。在2016年1月至2017年2月期间收集了这些患者（包括有和没有糖尿病的患者）的数据。使用电子数据库收集患者术前HbA浓度信息，并确定当术前HbA超过<69 mmol/mol的目标时是否导致手术延迟。
在纳入研究的1000例接受手术的患者（500例骨科患者和500例血管患者）中，201例（20%）患有糖尿病。在这201例糖尿病患者中，155例（77%）术前HbA<69 mmol/mol。在HbA超过推荐目标的46例糖尿病患者中，41例尽管HbA水平高仍接受了手术，只有5例因术前血糖控制不佳而推迟或取消了手术。
我们的数据表明，大多数（77%）接受择期血管和骨科手术的患者能够达到目标HbA<69 mmol/mol。因此，当前的术前指南在现实环境中是可以实现的。然而，正如国家指南中所述，只有在安全的情况下并需要一定临床判断时才应使用该目标。
