ABSTRACT
BACKGROUND: The authors examined whether poor preoperative glucose control, as indicated by the hemoglobin A1c (HbA1c) level of more than 8%, is associated with postoperative wound and infectious complications in diabetic patients that have undergone total knee arthroplasty (TKA). METHODS: One hundred and sixty-seven TKAs performed in 115 patients with type 2 diabetes mellitus, from January 2001 through March 2007, were retrospectively reviewed. Logistic regression was used to identify the variables that had a significant effect on the risk of wound complications or early deep infection. The variables considered were age, gender, body mass index, comorbidities, operation time, antibiotic-impregnated cement use, amount of blood transfusion, close suction drain use, duration of diabetes, method of diabetes treatment, diabetes complications, and preoperative HbA1c level. RESULTS: The overall incidence of wound complications was 6.6% (n = 11) and there were seven cases (4.2%) of early postoperative deep infection. Logistic regression revealed that the independent risk factors of wound complications were preoperative HbA1C > or = 8% (odds ratio [OR], 6.07; 95% confidence interval [CI], 1.12 to 33.0) and operation time (OR, 1.01; 95% CI, 1.00 to 1.03). No variable examined was found to be significantly associated with the risk of early postoperative deep infection. CONCLUSIONS: Poorly controlled hyperglycemia before surgery may increase the incidence of wound complications among diabetic patients after TKA.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Arthroplasty, Replacement, Knee/adverse effects , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/blood , Glucose/metabolism , Glycated Hemoglobin/metabolism , Hypoglycemic Agents/therapeutic use , Incidence , Insulin/therapeutic use , Logistic Models , Retrospective Studies , Surgical Wound Infection/metabolismABSTRACT
Se realiza un estudio prospectivo desde enero hasta el 31 de agosto de 1995. En este periodo se realizaron 152 intervenciones quirurgicas de las cuales el 55.9 por ciento fueron electivas, 39.5 por ciento urgencias y en el 4.6 por ciento reoperaciones. El procedimiento quirurgico mas frecuentemente realizado fue la colecistectomia (20.4 por ciento). Se detectaron 31 casos positivos con infeccion de la herida operatoria (IHO). La mayor parte de ellos fueron casos de cirugias de urgencia. El diagnostico de IHO se realizo antes de los 3 dias en 23 casos (74.2 por ciento) durante el posoperatorio. El germen aislado con mas frecuencia fue la E. Coli (63.2 por ciento). El antibiotico mas comunmente utilizado es la ampicilina. El antibiograma demostro resistencia a la ampicilina en el 92.2 por ciento de los casos