IMPACT OF PERIOPERATIVE AVERAGE BLOOD-GLUCOSE LEVEL ON PROGNOSIS OF PATIENTS WITH HIP FRACTURE AND DIABETES MELLITUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGGuoqi ¹ , LONGAnhua ^1,2 , ZHANGLihai ¹ , ZHANGHao ¹ , YINPeng ^1,2 ,  TANGPeifu ¹

1. Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;
2. School of Medicine, Nankai University;

Corresponding?author：

TANGPeifu, Email: pftang301@sohu.com

Keywords：

Hip fracture; Diabetes mellitus; Perioperation period; Fasting blood-glucose; Elderly patient

DOI：

10.7507/1002-1892.20140186

Video：

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Objective To explore the impact of perioperative average blood-glucose level on the prognosis of patients with hip fracture and diabetes mellitus. Methods A retrospective analysis was made on the clinical data of 244 patients with hip fracture and diabetes mellitus who accorded with the inclusion criteria between September 2009 and September 2012.Of 244 patients,125 patients with poorly controlled fasting blood-glucose (average fasting blood-glucose level >7.8 mmol/L) were assigned in group A,and 119 patients with well controlled fasting blood-glucose (average fasting blood-glucose level ≤7.8 mmol/L) were assigned in group B according to "China guideline for type 2 diabetes" criteria.There was no significant difference in gender,age,disease duration of diabetes mellitus,serum albumin,fracture type and disease duration,surgical procedure,anaesthesia,and complications between 2 groups (P>0.05).Group A had a higher hemoglobin level and fewer patients who can do some outdoor activities than group B (t=-2.353,P=0.020;χ²=4.333,P=0.037).The hospitalization time,days to await surgery,stitch removal time,the postoperative complication rate,the mortality at 1 month and 1 year after operation,and ambulatory ability at 1 year after operation were compared between the 2 groups. Results A total of 223 patients (114 in group A and 109 in group B) were followed up 12-15 months (mean,13.5 months).The days to await surgery of group A were significantly more than those of group B (t=-2.743,P=0.007),but no significant difference was found in hospitalization time and stitch removal time between 2 groups (P>0.05).The postoperative complication rate of group A (19.2%,24/125) was significantly higher than that of group B (8.4%,10/119)(χ²=5.926,P=0.015).Group A had a higher mortality at 1 month after operation than group B (6.1% vs.0)(χ²=5.038,P=0.025),but no significant difference was shown at 1 year after operation between groups A and B (8.8% vs.4.6%)(χ²=1.555,P=0.212).At 1 year after operation in patients who can do some outdoor activities,the proportions of patients who turned to do some indoor activities was 19.2%(15/78) in the group A and 13.5%(12/89) in group B,showing no significant difference (χ²=1.013,P=0.314). Conclusion Poorly controlled perioperative fasting blood-glucose may lead undesirable influence on the prognosis of patients with hip fracture and diabetes mellitus.In order to reduce the complication rate and other accidents,the fasting blood-glucose level should be controlled to 7.8mmol/L or less.

Citation： WANGGuoqi, LONGAnhua, ZHANGLihai, ZHANGHao, YINPeng, TANGPeifu. IMPACT OF PERIOPERATIVE AVERAGE BLOOD-GLUCOSE LEVEL ON PROGNOSIS OF PATIENTS WITH HIP FRACTURE AND DIABETES MELLITUS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 844-847. doi: 10.7507/1002-1892.20140186 Copy

1.	Ensrud KE.Epidemiology of fracture risk with advancing age.J Gerontol A Biol Sci Med Sci,2013,68(10):1236-1242.
2.	Haentjens P,Autier P,Barette M,et al.Survival and functional outcome according to hip fracture type:a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture.Bone,2007,41(6):958-964.
3.	Vestergaard P.Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes-a meta-analysis.Osteoporo Int,2007,18(4):427-444.
4.	Norris R,Parker M.Diabetes mellitus and hip fracture:a study of 5966 cases.Injury,2011,42(11):1313-1316.
5.	Ekstr?m W,Al-Ani AN,S??f M,et al.Health related quality of life,reoperation rate and function in patients with diabetes mellitus and hip fracture-a 2 year follow-up study.Injury,2013,44(6):769-775.
6.	Gulcelik NE,Bayraktar M,Caglar O,et al.Mortality after hip fracture in diabetic patients.Exp Clin Endocrinol Diabetes,2011,119(7):414-418.
7.	Vestergaard P,Rejnmark L,Mosekilde L.Diabetes and its complications and their relationship with risk of fractures in type 1 and 2 diabetes.Calcif Tissue Int,2009,84(1):45-55.
8.	Miao J,Brismar K,Nyrén O,et al.Elevated hip fracture risk in type 1 diabetic patients:a population-based cohort study in Sweden.Diabetes Care,2005,28(12):2850-2855.
9.	Reistetter TA,Graham JE,Deutsch A,et al.Diabetes comorbidity and age influence rehabilitation outcomes after hip fracture.Diabetes Care,2011,34(6):1375-1377.
10.	Wang H,Lu YW,Lan L,et al.Impact of diabetes on the prognosis of hip fracture:a cohort study in the Chinese population.Chin Med J (Engl),2013,126(5):813-818.
11.	Bolognesi MP,Marchant MH Jr,Viens NA,et al.The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States.J Arthroplasty,2008,23(6 Suppl 1):92-98.
12.	中國醫師協會糖尿病分會.中國2型糖尿病防治指南(2010年版).中國糖尿病雜志,2012,20(1):S1-S36.
13.	Lefaivre KA,Macadam SA,Davidson DJ,et al.Length of stay,mortality,morbidity and delay to surgery in hip fractures.J Bone Joint Surg (Br),2009,91(7):922-927.
14.	Bottle A,Aylin P.Mortality associated with delay in operation after hip fracture:observational study.BMJ,2006,332(7547):947-951.
15.	Fukui N,Watanabe Y,Nakano T,et al.Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury:a 1-year prospective cohort study.J Orthop Trauma,2012,26(3):163-171.
16.	Nikkel LE,Fox EJ,Black KP,et al.Impact of comorbidities on hospitalization costs following hip fracture.J Bone Joint Surg (Am),2012,94(1):9-17.
17.	Muller LM,Gorter KJ,Hak E,et al.Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus.Clin Infect Dis,2005,41(3):281-288.
18.	Bytzer P,Talley NJ,Leemon M,et al.Prevalence of gastrointestinal symptoms associated with diabetes mellitus:a population-based survey of 15,000 adults.Arch Intern Med,2001,161(16):1989-1996.
19.	de Kort S,Kruimel JW,Sels JP,et al.Gastrointestinal symptoms in diabetes mellitus,and their relation to anxiety and depression.Diabetes Res Clin Pract,2012,96(2):248-255.

1. Ensrud KE.Epidemiology of fracture risk with advancing age.J Gerontol A Biol Sci Med Sci,2013,68(10):1236-1242.
2. Haentjens P,Autier P,Barette M,et al.Survival and functional outcome according to hip fracture type:a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture.Bone,2007,41(6):958-964.
3. Vestergaard P.Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes-a meta-analysis.Osteoporo Int,2007,18(4):427-444.
4. Norris R,Parker M.Diabetes mellitus and hip fracture:a study of 5966 cases.Injury,2011,42(11):1313-1316.
5. Ekstr?m W,Al-Ani AN,S??f M,et al.Health related quality of life,reoperation rate and function in patients with diabetes mellitus and hip fracture-a 2 year follow-up study.Injury,2013,44(6):769-775.
6. Gulcelik NE,Bayraktar M,Caglar O,et al.Mortality after hip fracture in diabetic patients.Exp Clin Endocrinol Diabetes,2011,119(7):414-418.
7. Vestergaard P,Rejnmark L,Mosekilde L.Diabetes and its complications and their relationship with risk of fractures in type 1 and 2 diabetes.Calcif Tissue Int,2009,84(1):45-55.
8. Miao J,Brismar K,Nyrén O,et al.Elevated hip fracture risk in type 1 diabetic patients:a population-based cohort study in Sweden.Diabetes Care,2005,28(12):2850-2855.
9. Reistetter TA,Graham JE,Deutsch A,et al.Diabetes comorbidity and age influence rehabilitation outcomes after hip fracture.Diabetes Care,2011,34(6):1375-1377.
10. Wang H,Lu YW,Lan L,et al.Impact of diabetes on the prognosis of hip fracture:a cohort study in the Chinese population.Chin Med J (Engl),2013,126(5):813-818.
11. Bolognesi MP,Marchant MH Jr,Viens NA,et al.The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States.J Arthroplasty,2008,23(6 Suppl 1):92-98.
12. 中國醫師協會糖尿病分會.中國2型糖尿病防治指南(2010年版).中國糖尿病雜志,2012,20(1):S1-S36.
13. Lefaivre KA,Macadam SA,Davidson DJ,et al.Length of stay,mortality,morbidity and delay to surgery in hip fractures.J Bone Joint Surg (Br),2009,91(7):922-927.
14. Bottle A,Aylin P.Mortality associated with delay in operation after hip fracture:observational study.BMJ,2006,332(7547):947-951.
15. Fukui N,Watanabe Y,Nakano T,et al.Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury:a 1-year prospective cohort study.J Orthop Trauma,2012,26(3):163-171.
16. Nikkel LE,Fox EJ,Black KP,et al.Impact of comorbidities on hospitalization costs following hip fracture.J Bone Joint Surg (Am),2012,94(1):9-17.
17. Muller LM,Gorter KJ,Hak E,et al.Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus.Clin Infect Dis,2005,41(3):281-288.
18. Bytzer P,Talley NJ,Leemon M,et al.Prevalence of gastrointestinal symptoms associated with diabetes mellitus:a population-based survey of 15,000 adults.Arch Intern Med,2001,161(16):1989-1996.
19. de Kort S,Kruimel JW,Sels JP,et al.Gastrointestinal symptoms in diabetes mellitus,and their relation to anxiety and depression.Diabetes Res Clin Pract,2012,96(2):248-255.

Chinese Journal of Reparative and Reconstructive Surgery

IMPACT OF PERIOPERATIVE AVERAGE BLOOD-GLUCOSE LEVEL ON PROGNOSIS OF PATIENTS WITH HIP FRACTURE AND DIABETES MELLITUS

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