背景:血糖控制不佳与各种类型的手术后伤口并发症的风险增加有关。然而,目前尚不清楚血红蛋白A1c(HbA1c)和术前血糖如何用于预防非体外循环冠状动脉旁路移植术(OPCAB)后胸骨伤口并发症(SWC)的临床决策.
方法:我们对2010年1月至2016年11月期间接受OPCAB手术的1774例连续患者进行了回顾性研究。使用新的SWC四级分类。采用logistic回归分析和比例几率模型分析HbA1c、术前血糖与SWC发生率和分级的关系,分别。
结果:在326天的中位随访期间(四分位距(IQR)21-1261天),SWC发生在133/1316(10%)的非糖尿病患者和82/458(18%)的糖尿病患者中(p<0.001)。较高的HbA1c与较高的SWC发病率显著相关(比值比,或每增加1%1.24,95%置信区间,CI1.04;1.48,p=0.016)以及更高的SWC等级(OR1.25,95%CI1.06;1.48,p=0.010)。血糖与SWC的发生率(p=0.539)和分级(p=0.607)之间没有关联。发现了这些作用的重要修饰:HbA1c与70岁以下糖尿病患者的SWC相关(OR1.41,95%CI1.17;1.71,p<0.001),而不是70岁以上的人。非紧急手术患者的血糖与SWC相关(OR2.48,95%CI1.26;4.88,p=0.009),在接受骨骼移植的糖尿病患者中(OR4.83,95%CI1.28;18.17,p=0.020),在BMI<30的糖尿病患者中(OR2.19,95%CI1.01;4.76,p=0.047),而不是这些群体的对应群体。
结论:在一定条件下,HbA1c和血糖与OPCAB后的SWC相关。这些发现有助于以最小的SWC风险计划该程序。
BACKGROUND: Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB).
METHODS: We conducted a retrospective
study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively.
RESULTS: During a median follow-up of 326 days (interquartile range (IQR) 21-1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups.
CONCLUSIONS: Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC.