| ObjectiveTo analyze, summarize the characteristics of the perioperative period of the elderly with hip fracture, and the influence of HbAlc on perioperative complications by screening a numbers of clinical cases and other data for the purpose of exploring the use of HbAlc in perioperative evaluation and providing preliminary foundation for perioperative evaluation and prognosis.MethodThere were fifty-two cases of diabetic elderly with hip fracture admitted in our department form November2010to April2012in this retrospective study. The patients were analyzed and divided into two group by the levels of HbAlc:Group A(HbAlc less than6.4%);Group B(HbAlc greater than or equal to6.4%). Group A was the one of good glycemic control, while Group B was the poor glycemic control group. The two groups were quantitative analyzed in age, modified POSSUM score, preoperative preparation time, hospital stay, complication rate, standard deviation of blood glucose (SDBG) to compare the clinical data and evaluate the curative result. On the basis of HbAlc grouping, they were divided into four groups according to the level of preoperative blood glucose. The incidence of postoperative complications in each group were compared, to further clarify the impact of HbAlc on postoperative complications.Results1. There were17male and35female patients, male to female radio was0.49:1. They aged from62to95years old, the average age was78.47+6.95years old. Falling injury was the leading cause in all with a total of31cases(59.6%).33patients had been diagnosed with diabetes in their past medical history, accounting for63.4%; however the remaining19cases were diagnosed with diabetes for the first time during hospitalization, accounting for36.5%. Level3to4orthopedic surgeries were applied on all the patients. Postoperative complications occurred in24cases(46.2%)with lung infection in9cases, cardiac accident in7cases, urinary tract infection in8cases, Diabetic ketoacidosis in3cases, Upper gastrointestinal ulcers in2cases, Hypoglycemic coma in2cases and Decubitus in2cases.9cases had more than one kind of these complications. All the patients were cured and discharged from hospital without death.2. The patients were divided into two groups according to HbAlc:there were24cases in group A(HbAlc greater than or equal to6.4%), aged78.57±7.39years old, the average quantity of blood glucose before surgery was8.46±1.74mmol/L, the average modified POSSUM score was31.00±4.81, preoperative preparation time was10.13±4.79days, wound healing for14.42±0.97days, t SDGE was1.67±0.34mmol/L within the week after surgery, heir total hospital stay was22.40±1.9days, complication rate was46.6%.Group B(HbAlc less than6.4%), aged76.96±7.35yearsold, the average quantity of blood glucose before surgery was8.58±1.37mmol/L, the average modified POSSUM score was28.79±3.90, preoperative preparation time was6.68±1.85days, wound healing for14.00±0.72days, t SDGE was1.71±0.29mmol/L within the week after surgery, heir total hospital stay was23.71±2.68days, complication rate was32.1%.The two groups (A、B) were then divided into four groups:in group A, cases whose preoperative blood glucose≤8.9mmol/L(A1), their postoperative complication rate was41.6%. And the ones whose preoperative blood glucose>8.9mmol/L(A2), their postoperative complication rate was75%, with Statistically significant difference to Al.In group B, cases whose preoperative blood glucose≤8.9mmol/L(B1), their postoperative complication rate was33.3%. And the ones whose preoperative blood glucose>8.9mmol/L(B2), their postoperative complication rate was30.8%, without statistically significant difference to B1.Conclusion1.Elderly patients with hip fracture had a high incidence of diabetes, and the diabetic condition were unclear in many cases. Testing HbAlc make great sense to patients management during perioperative period, we can make timely diagnosis and treatment with them, and so that to make more fully preoperative preparation.2. The patients whose HbAlc greater than or equal to6.4%had greater postoperative blood glucose fluctuations, higher incidence of postoperative complications, longer hospital stay. But it did not made a significant impact on wound healing in diabetic elderly with hip fracture. The HbAlc played a certain role in the perioperative assessment.3. A more objective assessment of the condition of preoperative blood glucose control can be achieved by using HbAlc combined with instant preoperative blood glucose. For patients whose HbAlc<6.4%,the level of preoperative blood glucose control in8.9～llmmol/L was acceptable. It did not had a significant impact on postoperative complications. Whereases for those whose HbAlc≥6.4%, we should took more strict measures to preoperative blood glucose control. Controlling blood glucose under8.9mmol/L was helpful to reduce the incidence of postoperative complications, and ensuring the safety of the patient in the perioperative period. |
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