Surgical Outcomes of Total Knee Replacement According to Diabetes Status and Glycemic Control, 2001 to 2009
Surgical Outcomes of Total Knee Replacement According to Diabetes Status and Glycemic Control, 2001 to 2009
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DOI：
10.2106/jbjs.l.00109
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发表时间：
2013-03-20
影响因子：
5.3
通讯作者：
Namba, Robert S.
中科院分区：
文献类型：
--
作者：
Adams, Annette L.;Paxton, Elizabeth W.;Namba, Robert S.
背景：糖尿病患者血糖控制不良可能与不良手术结局相关。我们试图确定糖尿病状态和术前血糖控制与几种手术结果（包括关节成形术翻修和深部感染）的相关性。方法：我们在大型综合医疗保健组织的五个地区进行了一项回顾性队列研究。从Kaiser Permanente全关节置换登记系统中确定的合格受试者在2001年至2009年期间接受了择期首次初次全膝关节置换术。从电子病历中获得人口统计学、糖尿病状态、术前血红蛋白A1 c（HbA 1c）水平和合并症的数据。受试者被分为非糖尿病、HbA 1c < 7%的糖尿病患者（糖尿病控制）或HbA 1c>= 7%的糖尿病患者（糖尿病未控制）。结局为术后90天内的深静脉血栓形成或肺栓塞，翻修手术，深部感染，心肌梗死事件，以及术后1年内的全因再住院。在所有分析中，无糖尿病的患者为参照组。所有模型均根据年龄、性别、体重指数和Charlson Comorrhosis Index.Results进行调整：在接受全膝关节置换术的40，491例患者中，7567例（18.7%）患有糖尿病，464例（1.1%）接受翻修术，287例（0.7%）发生深部感染。与无糖尿病患者相比，糖尿病控制无相关性（HbA 1c < 7%）和翻修风险（比值比[OR]，1.32; 95%置信区间[Cl]，0.99 - 1.76），深部感染风险（OR，1.31; 95%CI，0.92 ~ 1.86），或深静脉血栓形成或肺栓塞的风险（OR，0.84; 95%CI，0.60 ~ 1.17）。同样，与无糖尿病患者相比，未控制的糖尿病（HbA 1c>= 7%）和翻修风险（OR，1.03; 95% CI，0.68 - 1.54），深部感染风险（OR，0.55; 95% CI 0.29至1.06），或深静脉血栓形成或肺栓塞的风险（OR，0.70; 95%CI，0.43 ~ 1.13）。关节翻修、深部感染的风险没有显著增加，或深静脉血栓在糖尿病患者中发现（根据术前HbA 1c水平和其他标准定义）与接受择期全膝关节置换术的研究人群中无糖尿病的患者相比。
Background: Poor glycemic control in patients with diabetes may be associated with adverse surgical outcomes. We sought to determine the association of diabetes status and preoperative glycemic control with several surgical outcomes, including revision arthroplasty and deep infection.Methods: We conducted a retrospective cohort study in five regions of a large integrated health-care organization. Eligible subjects, identified from the Kaiser Permanente Total Joint Replacement Registry, underwent an elective first primary total knee arthroplasty during 2001 through 2009. Data on demographics, diabetes status, preoperative hemoglobin A1c (HbA1c) level, and comorbid conditions were obtained from electronic medical records. Subjects were classified as nondiabetic, diabetic with HbA1c < 7% (controlled diabetes), or diabetic with HbA1c >= 7% (uncontrolled diabetes). Outcomes were deep venous thrombosis or pulmonary embolism within ninety days after surgery and revision surgery, deep infection, incident myocardial infarction, and all-cause rehospitalization within one year after surgery. Patients without diabetes were the reference group in all analyses. All models were adjusted for age, sex, body mass index, and Charlson Comorbidity Index.Results: Of 40,491 patients who underwent total knee arthroplasty, 7567 (18.7%) had diabetes, 464 (1.1%) underwent revision arthroplasty, and 287 (0.7%) developed a deep infection. Compared with the patients without diabetes, no association between controlled diabetes (HbA1c < 7%) and the risk of revision (odds ratio [OR], 1.32; 95% confidence interval [Cl], 0.99 to 1.76), risk of deep infection (OR, 1.31; 95% Cl, 0.92 to 1.86), or risk of deep venous thrombosis or pulmonary embolism (OR, 0.84; 95% Cl, 0.60 to 1.17) was observed. Similarly, compared with patients without diabetes, no association between uncontrolled diabetes (HbA1c >= 7%) and the risk of revision (OR, 1.03; 95% Cl, 0.68 to 1.54), risk of deep infection (OR, 0.55; 95% Cl 0.29 to 1.06), or risk of deep venous thrombosis or pulmonary embolism (OR, 0.70; 95% Cl, 0.43 to 1.13) was observed.Conclusions: No significantly increased risk of revision arthroplasty, deep infection, or deep venous thrombosis was found in patients with diabetes (as defined on the basis of preoperative HbA1c levels and other criteria) compared with patients without diabetes in the study population of patients who underwent elective total knee arthroplasty.