A Spoonful of Sugar: Commentary on an article by Annette L. Adams, PhD, MPH, et al.: “Surgical Outcomes of Total Knee Replacement According to Diabetes Status and Glycemic Control, 2001 to 2009”

第一作者：Paul Manner

2013-04-09 点击量：528 　　我要说

Nine years of data from Kaiser Permanente’s arthroplasty registry are reviewed in the study by Adams et al. The authors report on the relative risk of complications in patients with diabetes, and they also differentiate between patients with well-controlled and poorly controlled hyperglycemia. In brief, the authors assessed all patients undergoing primary total knee arthroplasty and categorized them according to glycemic status. They then examined postoperative surgical outcomes, including the need for revision, deep infection, and venous thromboembolic disease, as well as incident myocardial infarction and all-cause rehospitalization. With the exception of thromboembolic disease, one year of follow-up was used.

The study cohort included 40,491 patients; 81.3% were identified as not having had diabetes mellitus prior to the index surgery, 12.5% as having had controlled diabetes (hemoglobin [Hb] A1c level of <7.0%), and 6.2% as having had uncontrolled diabetes (HbA1c level of ≥7.0%). Within one year, 10,969 patients or 27.1% were rehospitalized for any reason, 1.1% or 464 required revision, 0.7% developed a deep infection, and 1.0% developed a myocardial infarction. When adjusted for age, sex, body mass index, and comorbidity score, there was no evidence of increased risks due to diabetes. Interestingly, glycemic control made no apparent difference—patients with an HbA1c level of 7.0% (considered the cutoff for adequate control) or more did as well as those with a lower value.

Diabetes is typically considered a predictor for perioperative complications, and there is no shortage of studies associating the presence of diabetes with increased surgical risk. Much work, both in the orthopaedic literature and in the surgical literature as a whole, has been reported on the establishment of appropriate parameters for blood sugar control.

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