Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Bone Joint Surg Am. 2022 Sep 21;104(18):1614-1620. doi: 10.2106/JBJS.21.00878. Epub 2022 Jul 22.
Increased serum glucose variability has been proposed as a risk factor for perioperative morbidity and mortality. Given the greater surgical complexity and complication risk of revision total joint arthroplasty (TJA), previous findings may not be generalizable to the revision population. The purpose of this study was to investigate the association between glucose variability and postoperative complications following aseptic revision TJA.
We identified 1,983 patients who underwent an aseptic revision TJA (636 total knee arthroplasties [TKAs] and 1,347 total hip arthroplasties [THAs]) from 2001 to 2019. Patients with ≥2 postoperative glucose values per day or ≥3 values during hospitalization were included in this study. Glucose variability was assessed using the coefficient of variation (COV). Outcomes included length of hospital stay, 90-day complications, mortality, and periprosthetic joint infection (PJI) as defined by the 2018 International Consensus Meeting criteria. Multivariate regression was used to determine the association between glucose variability and each end point, using COV as continuous and categorical variables (that is, COV tertiles).
Patients with high glycemic variability were at 1.7 times greater risk for 90-day complications (odds ratio [OR], 1.664 [95% confidence interval (CI), 1.266 to 2.188]; p < 0.001) and 2 times greater risk for PJI at a minimum 1-year follow-up (OR, 1.984 [95% CI, 1.270 to 3.100]; p = 0.003). The risk of 90-day complications increased by 2.2% (OR, 1.022 [95% CI, 1.012 to 1.032]; p < 0.001) and the risk of PJI increased by 1.8% (OR, 1.018 [95% CI, 1.003 to 1.034]; p = 0.013) for every percentage-point increase in COV. Patients with higher glucose variability also had a longer length of stay (beta, 1.028 days [95% CI, 0.590 to 1.466 days]; p < 0.001). These associations were independent of age, sex, body mass index, Charlson Comorbidity Index, involved joint, operative time, history of diabetes, and mean glucose levels.
Higher glucose variability was associated with an increased risk of medical complications and PJI following aseptic revision TJA. Patients undergoing these complex procedures should have glucose levels monitored closely in the perioperative period. Future studies should evaluate the utility of continuous glucose monitoring in this high-risk population.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
血清葡萄糖变异性增加被认为是围手术期发病率和死亡率的危险因素。鉴于翻修全关节置换术（TJA）的手术复杂性和并发症风险更高，之前的发现可能不适用于翻修人群。本研究旨在探讨无菌翻修 TJA 后葡萄糖变异性与术后并发症之间的关系。
我们从 2001 年至 2019 年期间确定了 1983 例接受无菌翻修 TJA（636 例全膝关节置换术 [TKA] 和 1347 例全髋关节置换术 [THA]）的患者。每天至少有 2 个术后血糖值或住院期间至少有 3 个血糖值的患者纳入本研究。使用变异系数（COV）评估葡萄糖变异性。结局包括住院时间、90 天并发症、死亡率和根据 2018 年国际共识会议标准定义的假体周围关节感染（PJI）。使用多元回归分析评估 COV 作为连续和分类变量（即 COV 三分位数）与每个终点之间的关系。
高血糖变异性患者发生 90 天并发症的风险增加 1.7 倍（优势比 [OR]，1.664 [95%置信区间（CI），1.266 至 2.188]；p <0.001），在至少 1 年的随访中发生 PJI 的风险增加 2 倍（OR，1.984 [95%CI，1.270 至 3.100]；p = 0.003）。COV 每增加 1%，90 天并发症的风险增加 2.2%（OR，1.022 [95%CI，1.012 至 1.032]；p <0.001），PJI 的风险增加 1.8%（OR，1.018 [95%CI，1.003 至 1.034]；p = 0.013）。高血糖变异性患者的住院时间也更长（β，1.028 天[95%CI，0.590 至 1.466 天]；p <0.001）。这些关联独立于年龄、性别、体重指数、Charlson 合并症指数、受累关节、手术时间、糖尿病史和平均血糖水平。
无菌翻修 TJA 后，较高的血糖变异性与医疗并发症和 PJI 的风险增加相关。接受这些复杂手术的患者应在围手术期密切监测血糖水平。未来的研究应评估在这个高危人群中连续血糖监测的效用。
预后 III 级。请参阅作者说明，以获取完整的证据水平描述。
