High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery
High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery
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DOI：
10.1007/s00776-013-0518-7
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发表时间：
2014-03-01
影响因子：
1.7
通讯作者：
Matsumoto, Morio
中科院分区：
文献类型：
--
作者：
Hikata, Tomohiro;Iwanami, Akio;Matsumoto, Morio
据报道，糖尿病(DM)是手术部位感染(SSI)的危险因素，SSI是脊柱手术后的严重并发症。DM对脊柱内固定术后SSI的影响尚不清楚。本研究的目的是阐明DM患者后路胸腰椎融合术后手术部位感染的危险因素。研究对象包括2005-2011年间接受后路内固定术的胸腰椎关节融合术患者，术后可随访至少1年。其中糖尿病患者36例(男性19例，女性17例；平均年龄64.3岁)。回顾患者的病历以确定SSI的发生率。糖尿病患者的SSI发生率(6/36，16.7%)明显高于非糖尿病患者(10/309，3.2%)。尽管发生SSI的DM患者与未发生SSI的DM患者围手术期血糖水平无差异，但发生SSI的DM患者术前糖化血红蛋白(HbA1c)值(7.6%)显著高于未发生SSI的患者(6.9%)。糖尿病控制组(HbA1c和HbA1c)发生SSI的比例为0.0%(HbA1c和HbA1c)，未控制糖尿病患者的SSI发生率为35.3%(HbA1c/千分之7.0%)。术前血糖控制不佳的糖尿病患者发生SSI的风险较高。为了预防糖尿病患者的SSI，我们建议在手术前将HbA1c降低到7.0%。
Diabetes mellitus (DM) is reported to be a risk factor for surgical site infection (SSI), which is a serious complication after spinal surgery. The effect of DM on SSI after instrumented spinal surgery remains to be clarified. The aim was to elucidate perioperative risk factors for infection at the surgical site after posterior thoracic and lumbar spinal arthrodesis with instrumentation in patients with DM.Consecutive patients who underwent posterior instrumented thoracic and lumbar spinal arthrodesis during the years 2005-2011, who could be followed for at least 1 year after surgery, were included. These included 36 patients with DM (19 males and 17 females; mean age 64.3 years). The patients' medical records were retrospectively reviewed to determine the SSI rate. The characteristics of the DM patients were examined in detail, including the levels of serum glucose and HbA1c, which indicate the level of diabetes control.Patients with DM had a higher rate of SSI (6 of 36 patients, 16.7 %) than patients without DM (10 of 309 patients, 3.2 %). Although the perioperative serum glucose level did not differ between DM patients that did or did not develop SSI, the preoperative HbA1c value was significantly higher in the patients who developed SSI (7.6 %) than in those who did not (6.9 %). SSI developed in 0.0 % of the patients with controlled diabetes (HbA1c < 7.0 %) and in 35.3 % of the patients with uncontrolled diabetes (HbA1c a parts per thousand yen7.0 %).DM patients whose blood glucose levels were poorly controlled before surgery were at high risk for SSI. To prevent SSI in DM patients, we recommend lowering the HbA1c to < 7.0 % before performing surgery.