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Impact of Diabetes and Glycemic Control on Surgical Outcomes in Total Knee Replacement

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This study analyzes the outcomes of total knee replacement (TKA) surgery from 2001 to 2009, focusing on the effects of diabetes status and glycemic control. Patients with diabetes may face surgical complications, but our findings indicate that preoperative glycemic levels do not significantly increase the risk of adverse outcomes such as revision surgery, deep infections, thromboembolism, or myocardial infarction. Notably, the study suggests that other factors like gender, BMI, and comorbidities may play a more pivotal role in influencing surgical results than diabetes itself.

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Impact of Diabetes and Glycemic Control on Surgical Outcomes in Total Knee Replacement

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  1. Surgical Outcomes of Total Knee ReplacementAccording to Diabetes Status and GlycemicControl, 2001 to 2009 血糖对于全膝关节置换术的影响

  2. 背景 血糖控制较差的病人可能产生手术并发症：血栓、深部感染等； 假设：术前糖尿病状态及血糖控制水平和术后手术结果相关；

  3. 方法 回顾性分析三组初次膝关节置换患者 无糖尿病组（32,924例） 血糖控制组（HbA1c < 7.0%）（5042例） 血糖未控制组（HbA1c≥ 7.0%）（2525例） 分析血栓栓塞与肺栓塞、翻修、深部感染、心肌梗死、再入院率有无差别。

  4. 性别、BMI指数、基础疾病、抗生素应用

  5. 结果 糖尿病患者中男性比例增加； 糖尿病患者中肥胖者更多； 糖尿病患者中基础疾病及其严重程度增大； 糖尿病患者术中使用抗生素骨水泥比例增加；

  6. 结果

  7. 翻修 • 调整：性别、年龄、BMI等；

  8. 深部感染 • 调整：性别、年龄、BMI等；

  9. 血栓栓塞 • 调整：性别、年龄、BMI等；

  10. 心肌梗死 • 调整：性别、年龄、BMI等；

  11. 二次入院 • 调整：性别、年龄、BMI等；

  12. 结果 糖尿病患者深部感染、血栓的发生率也较低； 血糖控制不佳者似乎不造成更高的心肌梗死及再次入院率；

  13. 结果 与非糖尿病患者相比： 血糖控制组与翻修、深部感染、深静脉栓塞及肺栓塞无相关关系； 血糖未控制组与翻修、深部感染、深静脉栓塞及肺栓塞无相关关系；

  14. 结论 • TKA： 糖尿病并不能增加翻修、深部感染、深静脉栓塞及肺栓塞的风险；

  15. 讨论 与既往文献不一致原因： 1.各类结果数量相对较少； 2.血糖控制不佳组病例数较少； 3.创新使用糖化血红蛋白评价指标； 4.使用ICD-9编码系统及实验室标准；

  16. 讨论 性别、BMI指数、其它基础疾病与围手术期血糖控制水平相比更可能产生不良手术结果；

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