术前血糖控制（HbA1c）与原发性髋关节和膝关节置换术后早期预后的关系

IF 4.6 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2025-06-01 DOI:10.1302/0301-620X.107B6.BJJ-2024-1136.R1

Richard James Holleyman, Michael Clarkson, Amy Shenfine, Kate Martin, James Prentis, Mark Bowditch, Gerry Rayman, Andrew Judge, Mike R Reed

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引用次数: 0

摘要

目的：本研究探讨髋关节和膝关节置换术患者糖尿病（DM）、糖化血红蛋白（HbA1c）与术后预后的关系。方法：我们对2008年6月至2019年12月期间接受原发性髋关节或膝关节置换术的患者进行了一项单中心队列研究，并记录了术前HbA1c。根据术前HbA1c分为“糖尿病”（≥48 mmol/mol）、“前驱糖尿病”（≥42 mmol/mol和< 48 mmol/mol）、“无糖尿病”（< 42 mmol/mol）或“缓解”（术前HbA1c < 42 mmol/mol，但历史HbA1c结果≥42 mmol/mol）。采用多变量logistic回归和限制三次样条来检验糖尿病状态、HbA1c和早期术后结局之间的关系。结果:对9454例手术（18.4%为糖尿病，23.5%为糖尿病前期，49.7%为无糖尿病，8.4%为缓解期）的分析显示，糖尿病与发生一种或多种术后并发症的可能性增加50%相关（比值比（or） 1.47 (95% CI 1.26至1.71)），急性肾损伤或电解质异常的风险增加60%相关（or 1.57 (95% CI 1.33至1.87)）。术后尿路感染（OR 2.25 (95% CI 1.15至4.52)）和深部手术部位感染（OR 2.03 (95% CI 1.05至3.86)）的风险是无糖尿病患者的两倍多。当HbA1c进入糖尿病前期范围时，并发症风险大幅增加，没有证据表明存在平台效应或阈值效应，并且在先前HbA1c升高的患者中，几乎所有记录的并发症风险都显著降低。结论：糖尿病与几乎所有早期术后并发症的风险增加有关。降低HbA1c升高的干预措施在任何程度上都可能有利于患者的预后，但这些干预措施必须与医源性危害的风险相平衡。

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Association between preoperative glycaemic control (HbA1c) and early outcomes following primary hip and knee arthroplasty.

Aims: This study investigates the relationship between diabetes mellitus (DM), glycated haemoglobin (HbA1c), and postoperative outcomes among patients undergoing hip and knee arthroplasty.

Methods: We conducted a single-centre cohort study of patients who underwent primary hip or knee arthroplasty between June 2008 and December 2019 and for whom preoperative HbA1c had been recorded. Cases were categorized by preoperative HbA1c as 'diabetes' (≥ 48 mmol/mol), 'prediabetes' (≥ 42 mmol/mol and < 48 mmol/mol), 'no diabetes' (< 42 mmol/mol), or in 'remission' (preoperative HbA1c < 42 mmol/mol but having a historic HbA1c result ≥ 42 mmol/mol). Multivariable logistic regression and restricted cubic splines were used to examine the association between diabetes status, HbA1c, and early postoperative outcomes.

Results: Analysis of 9,454 procedures (18.4% diabetes, 23.5% prediabetes, 49.7% no diabetes, 8.4% in remission) revealed that DM was associated with a 50% greater likelihood of experiencing one or more postoperative complications (odds ratio (OR) 1.47 (95% CI 1.26 to 1.71)), a 60% greater risk of acute kidney injury or electrolyte abnormality (OR 1.57 (95% CI 1.33 to 1.87)), and more than double the risk of postoperative urinary tract infection (OR 2.25 (95% CI 1.15 to 4.52)) and deep surgical site infection (OR 2.03 (95% CI 1.05 to 3.86)) compared to individuals without diabetes. There was a substantial increase in complication risk as HbA1c entered prediabetes range with no evidence of a plateau or threshold effect, and a profound reduction in the risk of almost all recorded complications for patients in remission from previously elevated HbA1c.

Conclusion: DM was associated with an increased risk of almost all measured early postoperative complications. Interventions to reduce elevated HbA1c, to any degree, may benefit patient outcomes, however these must be balanced with the risk of iatrogenic harm.

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来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

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