Background: 

Increased serum glucose variability has been proposed as a risk factor for perioperative morbidity and mortality. Given the greater surgical complexity and complication risk of revision total joint arthroplasty (TJA), previous findings may not be generalizable to the revision population. The purpose of this study was to investigate the association between glucose variability and postoperative complications following aseptic revision TJA.

Methods: 

We identified 1,983 patients who underwent an aseptic revision TJA (636 total knee arthroplasties [TKAs] and 1,347 total hip arthroplasties [THAs]) from 2001 to 2019. Patients with ≥2 postoperative glucose values per day or ≥3 values during hospitalization were included in this study. Glucose variability was assessed using the coefficient of variation (COV). Outcomes included length of hospital stay, 90-day complications, mortality, and periprosthetic joint infection (PJI) as defined by the 2018 International Consensus Meeting criteria. Multivariate regression was used to determine the association between glucose variability and each end point, using COV as continuous and categorical variables (that is, COV tertiles).

Results: 

Patients with high glycemic variability were at 1.7 times greater risk for 90-day complications (odds ratio [OR], 1.664 [95% confidence interval (CI), 1.266 to 2.188]; p < 0.001) and 2 times greater risk for PJI at a minimum 1-year follow-up (OR, 1.984 [95% CI, 1.270 to 3.100]; p = 0.003). The risk of 90-day complications increased by 2.2% (OR, 1.022 [95% CI, 1.012 to 1.032]; p < 0.001) and the risk of PJI increased by 1.8% (OR, 1.018 [95% CI, 1.003 to 1.034]; p = 0.013) for every percentage-point increase in COV. Patients with higher glucose variability also had a longer length of stay (beta, 1.028 days [95% CI, 0.590 to 1.466 days]; p < 0.001). These associations were independent of age, sex, body mass index, Charlson Comorbidity Index, involved joint, operative time, history of diabetes, and mean glucose levels.

Conclusions: 

Higher glucose variability was associated with an increased risk of medical complications and PJI following aseptic revision TJA. Patients undergoing these complex procedures should have glucose levels monitored closely in the perioperative period. Future studies should evaluate the utility of continuous glucose monitoring in this high-risk population.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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血清葡萄糖变异性增加无菌翻修髋膝关节置换术后并发症的风险

背景： 

增加的血糖变异性已被认为是围手术期发病率和死亡率的危险因素。鉴于翻修全关节置换术 (TJA) 的手术复杂性和并发症风险更高，以前的研究结果可能无法推广到翻修人群。本研究的目的是探讨无菌翻修 TJA 后血糖变异性与术后并发症之间的关系。

方法： 

我们确定了 2001 年至 2019 年期间接受无菌翻修 TJA 的 1,983 名患者（636 例全膝关节置换术 [TKA] 和 1,347 例全髋关节置换术 [THA]）。术后血糖值每天≥2 或住院期间血糖值≥3 的患者被纳入这项研究。使用变异系数 (COV) 评估葡萄糖变异性。结果包括 2018 年国际共识会议标准定义的住院时间、90 天并发症、死亡率和假体周围感染 (PJI)。多元回归用于确定葡萄糖变异性与每个终点之间的关联，使用 COV 作为连续变量和分类变量（即 COV 三分位数）。

结果： 

具有高血糖变异性的患者发生 90 天并发症的风险高 1.7 倍（优势比 [OR]，1.664 [95% 置信区间 (CI)，1.266 至 2.188]；p < 0.001）和 PJI 风险高 2 倍至少 1 年的随访（OR，1.984 [95% CI，1.270 至 3.100]；p = 0.003）。90 天并发症的风险增加了 2.2%（OR，1.022 [95% CI，1.012 到 1.032]；p < 0.001），PJI 的风险增加了 1.8%（OR，1.018 [95% CI，1.003 到 1.034） ]；p = 0.013)，COV 每增加一个百分点。血糖变异性较高的患者住院时间也较长（β，1.028 天 [95% CI，0.590 至 1.466 天]；p < 0.001）。这些关联与年龄、性别、体重指数、查尔森合并症指数、涉及的关节、手术时间、糖尿病史和平均血糖水平无关。

结论： 

较高的葡萄糖变异性与无菌性翻修 TJA 后医疗并发症和 PJI 的风险增加有关。接受这些复杂程序的患者应在围手术期密切监测血糖水平。未来的研究应评估持续血糖监测在这一高危人群中的效用。

证据等级： 

预后等级 III。有关证据级别的完整描述，请参见作者说明。