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首页> 外文期刊>Journal of Hand Surgery. American Volume >Insulin Dependence Is Associated With Increased Risk?of?Complications After Upper Extremity Surgery?in?Diabetic Patients
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Insulin Dependence Is Associated With Increased Risk?of?Complications After Upper Extremity Surgery?in?Diabetic Patients

机译：胰岛素依赖性与风险增加有关？上肢手术后的并发症？在糖尿病患者中

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Diabetes mellitus (DM) is associated with the development of carpal tunnel syndrome, Dupuytren disease, trigger digits, and limited joint mobility. Despite descriptions of poorer response to nonsurgical treatment, previous studies have not shown increased complication rates in diabetic patients after hand surgery. Few studies, however, differentiate between insulin-dependent (IDDM) and non–insulin-dependent (NIDDM) diabetes mellitus. The purpose of this study was to evaluate the impact of insulin dependence on the postoperative risk profile of diabetic patients after hand surgery using a national database. Materials and methodsThe data were obtained through the National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing surgery from the distal humerus to the hand, between 2005 and 2015, were identified using 297 distinct Current Procedural Terminology codes. Thirty-day postoperative complications were collected and categorized into medical complications, surgical site complications, and readmission. Surgical complications, medical complications, and readmissions were compared between patients with NIDDM or IDDM to those without DM using multivariable logistic regression, adjusting for baseline patient and operative characteristics. ResultsThe study cohort included 52,727 patients. Patients with IDDM had a 5.7% overall complication rate compared with 2.3% and 1.5% in NIDDM and nondiabetic patients, respectively. After controlling for differences in patient and surgical characteristics, patients with IDDM had a statistically significant increased rate of any complication, surgical site complications, superficial surgical site infections, and readmission. There was no significant difference in complication rates between patients with NIDDM and nondiabetic patients. ConclusionsOur data demonstrate a greater risk of complications following hand and upper extremity surgery for patients with IDDM, specifically surgical site infections. The NIDDM patients did not have an increased rate of complications relative to nondiabetic patients. These findings are important for patient risk stratification and may guide further investigation to decrease complication rates in IDDM patients after upper extremity surgery. Type of study/level of evidencePrognostic II.
机译：糖尿病（DM）与腕管综合征，Dupuytren疾病，触发数字和有限的联合移动性有关。尽管对非静电治疗的反应较差的描述，但前面的研究在手术后患糖尿病患者的并发症率没有提高。然而，很少有研究区分胰岛素依赖性（IDDM）和非胰岛素依赖性（NIDDM）糖尿病。本研究的目的是评估胰岛素依赖对使用国家数据库手术后手术后糖尿病患者术后风险概况的影响。通过国家外科质量改进计划（NSQIP）数据库获得材料和方法。 2005年至2015年间，从远端肱骨到手术中接受手术的患者使用297个不同的流程术语术语核查。收集了30天的术后并发症，并分为医学并发症，手术部位并发症和入院。在使用多变量逻辑回归的情况下，使用多变量逻辑回归，对那些没有DM的人进行手术并发症，医疗并发症和再生，调整基线患者和手术特征。结果研究队列包括52,727名患者。 IDDM患者的整体并发症率为5.7％，而Niddm和Nondiabicetic患者分别比较2.3％和1.5％。在控制患者和手术特征的差异后，IDDM患者在统计学上显着增加了任何并发症，手术部位并发症，表面外科手术部位感染和再次入院率。 NIDDM和非奶粉患者患者的并发症率没有显着差异。结论您的数据表明，IDDM患者手术和上肢手术后的并发症风险更大，特别是手术部位感染。 NIDDM患者在非糖尿病患者中没有增加的并发症率。这些发现对于患者风险分层很重要，并可进一步调查在上肢手术后降低IDDM患者的并发症率。学习类型/证据预备II的水平。

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