Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz.
Boston University School of Public Health, Boston, Mass.
J Vasc Surg. 2021 Apr;73(4):1332-1339.e5. doi: 10.1016/j.jvs.2020.05.036. Epub 2020 Jul 28.
Diabetes has been shown to be associated with increased risk of postoperative complications after lower extremity bypass (LEB), although it is unclear whether medium-term glucose control affects outcomes. This study aimed to assess the association of perioperative hemoglobin A (HbA) level on perioperative outcomes after LEB.
We examined consecutive infrainguinal LEBs for chronic limb-threatening ischemia (CLTI) using the Vascular Quality Initiative database (2007-2018). Perioperative HbA levels were stratified into <5.7%, 5.7% to 6.5%, and >6.5%. Propensity score matching on demographics, medical history, and procedural characteristics was used to select comparable patients across HbA groups. The primary outcome was postoperative wound infection. Multivariable analyses were performed for matched and unmatched groups using Cox proportional hazards models for survival outcomes and logistic regression for binary outcomes with association expressed by adjusted hazard ratio (aHR) or adjusted odds ratio (aOR) and corresponding 95% confidence intervals (CIs).
The CLTI cohort included 8171 infrainguinal LEBs: 631 (7.7%) had HbA <5.7%; 1691 (20.6%), 5.7% to 6.5%; and 5849 (71.6%), >6.5%. There was no difference in rates of wound infection in the CLTI cohort (HbA ≤5.7%, 3.8%; HbA 5.7%-6.5%, 3.7%; HbA >6.5%, 3.2%; P = .53) or matched cohort (4.3%, 4.5%, 3.4%; P = .62). There were no differences in perioperative mortality in the CLTI cohort (2.5%, 1.7%, 1.5%; P = .16) or the matched cohort (2.7%, 2.3%, 2.2%; P = .84). In multivariable analysis, there was no significant association between HbA and wound infection in the CLTI cohort (HbA 5.7%-6.5% vs <5.7%: aOR, 0.91 [95% CI, 0.56-1.50; P = .72]; HbA >6.5% vs <5.7%: aOR, 0.81 [95% CI, 0.52-1.26; P = .35]). There was, however, a significant association between decreased HbA and mortality (HbA 5.7%-6.5% vs <5.7%: aHR, 0.77 [95% CI, 0.61-0.97; P = .03]; HbA >6.5% vs <5.7%: aHR, 0.75 [95% CI, 0.61-0.93; P = .01]).
Our study suggests no significant association of increased HbA level and perioperative complications. Additional investigation is required to further evaluate the impact of short-term glycemic control and long-term outcomes of patients undergoing LEB.
已有研究表明，糖尿病与下肢旁路术（LEB）后术后并发症的风险增加有关，但尚不清楚中期血糖控制是否会影响结果。本研究旨在评估 LEB 围手术期血红蛋白 A（HbA）水平与围手术期结局的关系。
我们使用血管质量倡议数据库（2007-2018 年）对慢性肢体威胁性缺血（CLTI）进行连续的下肢旁路术。将围手术期 HbA 水平分为<5.7%、5.7%-6.5%和>6.5%。使用倾向评分匹配在人口统计学、病史和手术特征方面对 HbA 组进行匹配，以选择可比的患者。主要结局是术后伤口感染。使用 Cox 比例风险模型对匹配和非匹配组进行多变量分析，以获得生存结果，并使用逻辑回归对二项结果进行分析，调整后的危险比（aHR）或调整后的优势比（aOR）和相应的 95%置信区间（CI）表示关联。
CLTI 队列包括 8171 例下肢旁路术：631 例（7.7%）HbA<5.7%；1691 例（20.6%），5.7%-6.5%；5849 例（71.6%），>6.5%。在 CLTI 队列中，伤口感染的发生率没有差异（HbA≤5.7%，3.8%；HbA 5.7%-6.5%，3.7%；HbA>6.5%，3.2%；P=0.53）或匹配队列（4.3%，4.5%，3.4%；P=0.62）。在 CLTI 队列中，围手术期死亡率没有差异（2.5%，1.7%，1.5%；P=0.16）或匹配队列（2.7%，2.3%，2.2%；P=0.84）。多变量分析显示，HbA 与 CLTI 队列中的伤口感染之间无显著关联（HbA 5.7%-6.5%与<5.7%：aOR，0.91 [95%CI，0.56-1.50；P=0.72]；HbA>6.5%与<5.7%：aOR，0.81 [95%CI，0.52-1.26；P=0.35]）。然而，HbA 与死亡率之间存在显著关联（HbA 5.7%-6.5%与<5.7%：aHR，0.77 [95%CI，0.61-0.97；P=0.03]；HbA>6.5%与<5.7%：aHR，0.75 [95%CI，0.61-0.93；P=0.01]）。
本研究表明，HbA 水平升高与围手术期并发症之间没有显著关联。需要进一步的研究来进一步评估患者接受 LEB 后的短期血糖控制和长期结果的影响。
