血清果糖胺作为足踝手术患者围手术期并发症的指标
Serum Fructosamine as an Indicator of Perioperative Complications in Patients Undergoing Foot and Ankle Surgery.
作者信息
Suh Yu Min, Fisher Margaret, Hu Di, Lin Feng-Chang, Wukich Dane, Tennant Josh, Lalli Trapper
机构信息
Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA.
出版信息
Foot Ankle Orthop. 2024 Jul 29;9(3):24730114241263093. doi: 10.1177/24730114241263093. eCollection 2024 Jul.
BACKGROUND
Patients with poor glycemic control are at increased risk of postoperative complications. Hemoglobin A (HbA) has traditionally been used to assess preoperative glycemic control, but with limitations. More recently, fructosamine has been tested preoperatively in patients undergoing elective total joint arthroplasty. This study aims to assess whether preoperative serum fructosamine can be used to avoid adverse outcomes in patients undergoing foot and ankle surgery.
METHODS
This was a retrospective chart review of all patients who underwent foot and ankle surgeries at 2 level 1 trauma centers from January 2020 to December 2021. Of those, 305 patients were tested for HbA and fructosamine levels preoperatively. Adverse outcomes were assessed over 30 and 90 days. Outcomes of interest were surgical site infection, wound dehiscence, unplanned return to the operating room, unplanned readmission, and death. Data were analyzed using independent 2-sample tests. A mixed effects model was used for multivariate analysis. values less than .05 were considered statistically significant.
RESULTS
Preoperative serum fructosamine was significantly higher ( = .029) in those with complications within 90 days compared to those without. The mean preoperative fructosamine level was 269.2 µmol/L (SD = 58.85) in those who did have a complication vs 247.2 µmol/L (SD = 53.95) in those who did not. Clinically significant fructosamine threshold was determined using 2 different methods. Fructosamine was found to be non-inferior to HbA in accurately predicting postoperative complications.
CONCLUSION
Fructosamine is a serum marker that reflects nearer term glycemic control than HbA. Elevation in preoperative fructosamine is associated with increased perioperative complications after foot and ankle surgery within 90 days. Preoperative fructosamine may be used in patient optimization and risk stratification when determining candidacy and timing for elective foot and ankle surgeries.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
背景
血糖控制不佳的患者术后并发症风险增加。传统上，血红蛋白A（HbA）一直用于评估术前血糖控制情况，但存在局限性。最近，已对接受择期全关节置换术的患者在术前检测了果糖胺。本研究旨在评估术前血清果糖胺是否可用于避免足踝手术患者出现不良结局。
方法
这是一项对2020年1月至2021年12月在2家一级创伤中心接受足踝手术的所有患者进行的回顾性病历审查。其中，305例患者术前检测了HbA和果糖胺水平。在30天和90天内评估不良结局。感兴趣的结局包括手术部位感染、伤口裂开、计划外返回手术室、计划外再入院和死亡。使用独立双样本检验分析数据。采用混合效应模型进行多变量分析。P值小于0.05被认为具有统计学意义。
结果
与无并发症的患者相比，90天内出现并发症的患者术前血清果糖胺显著更高（P = 0.029）。出现并发症的患者术前果糖胺平均水平为269.2µmol/L（标准差 = 58.85），而未出现并发症的患者为247.2µmol/L（标准差 = 53.95）。使用2种不同方法确定了具有临床意义的果糖胺阈值。发现果糖胺在准确预测术后并发症方面不劣于HbA。
结论
果糖胺是一种比HbA更能反映近期血糖控制情况的血清标志物。术前果糖胺升高与足踝手术后90天内围手术期并发症增加相关。在确定择期足踝手术的候选资格和时机时，术前果糖胺可用于患者优化和风险分层。
证据水平
III级，回顾性队列研究。
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