Department of Orthopaedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopaedics and National Clinical Research Center for Geriatrics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2021 May;13(3):719-733. doi: 10.1111/os.12944. Epub 2021 Mar 18.
To investigate the proportion of insulin-dependent diabetes mellitus (IDDM) patients among diabetic patients undergoing total joint arthroplasty (TJA) and whether insulin dependence is associated with postoperative complications.
A systematic literature search was performed in EMBASE, PubMed, Ovid, Medline, the Cochrane Library, Web of Science, the China Science and Technology Journal Database, and China National Knowledge Infrastructure from the inception dates to 10 September 2019. Observational studies reporting adverse events with IDDM following TJA were included. Primary outcomes were cardiovascular complications, pulmonary complications, kidney complications, wound complications, infection, and other complications within 30 days of surgery. Secondary outcomes were the proportion of IDDM patients among diabetic patients undergoing TJA and its time trend.
A total of 19 studies involving 85,689 participants were included. Among patients undergoing TJA, 26% of diabetic patients had IDDM. Compared with non-insulin-dependent diabetes (NIDDM), the incidences of cardiac arrest (risk ratio [RR], 2.346; 95% confidence interval [CI], 1.553 to 3.546), renal failure (relative risk [RR], 2.758; 95% CI, 1.830 to 4.156), deep incisional surgical site infection (RR, 1.968; 95% CI, 1.107 to 3.533), wound dehiscence (RR, 2.209; 95% CI, 1.830 to 4.156), and death (RR, 2.292; 95% CI, 1.568 to 3.349) were all significantly increased in IDDM. A significant time trend was witnessed for the prevalence of IDDM (P = 0.014). There was no statistical significance for organ/space surgical site infection, thrombotic events (deep venous thrombosis/ pulmonary embolism), and revision rates.
Insulin-dependent diabetes is an independent high-risk factor for increased adverse outcomes relative to NIDDM, suggesting that hierarchical and optimal blood glucose management may contribute to reducing the adverse complications after surgery for these patients. In addition, because the risk of sepsis, deep wound infection, organ/space surgical site infection, urinary tract infection, renal insufficiency, and renal failure significantly increase after TJA in IDDM patients, more active postoperative antimicrobial prophylaxis may be needed on the premise of protecting renal function.
调查行全关节置换术（TJA）的糖尿病患者中胰岛素依赖型糖尿病（IDDM）患者的比例，以及胰岛素依赖是否与术后并发症相关。
系统检索 EMBASE、PubMed、Ovid、Medline、Cochrane 图书馆、Web of Science、中国科技期刊数据库和中国国家知识基础设施，检索时间从建库至 2019 年 9 月 10 日。纳入报告 TJA 后 IDDM 患者发生不良事件的观察性研究。主要结局为术后 30 天内的心血管并发症、肺部并发症、肾脏并发症、伤口并发症、感染和其他并发症。次要结局为 TJA 患者中糖尿病患者中 IDDM 的比例及其时间趋势。
共纳入 19 项研究，涉及 85689 名参与者。在接受 TJA 的患者中，26%的糖尿病患者患有 IDDM。与非胰岛素依赖型糖尿病（NIDDM）相比，心脏骤停的发生率（风险比 [RR]，2.346；95%置信区间 [CI]，1.553 至 3.546）、肾衰竭（相对风险 [RR]，2.758；95% CI，1.830 至 4.156）、深部切口手术部位感染（RR，1.968；95% CI，1.107 至 3.533）、伤口裂开（RR，2.209；95% CI，1.830 至 4.156）和死亡（RR，2.292；95% CI，1.568 至 3.349）的发生率均显著增加。IDDM 的患病率呈显著的时间趋势（P = 0.014）。器官/空间手术部位感染、血栓事件（深静脉血栓形成/肺栓塞）和翻修率无统计学意义。
与 NIDDM 相比，胰岛素依赖型糖尿病是增加不良结局的独立高危因素，提示对这些患者进行分级和优化血糖管理可能有助于减少术后不良并发症。此外，由于 IDDM 患者 TJA 后败血症、深部伤口感染、器官/空间手术部位感染、尿路感染、肾功能不全和肾衰竭的风险显著增加，在保护肾功能的前提下，可能需要更积极的术后抗菌预防。
