Andres Rodriguez-Buitrago1, Attum Basem2, Ebubechi Okwumabua3, Nichelle Enata4, Adam Evans5, Jacquelyn Pennings6, Bernes Karacay7, Mark John Rice8, William Obremskey9. 1. Division of Orthopaedic Trauma, Vanderbilt Medical Center, 1215st Avenue South, Nashville, TN, 37212, United States; Universidad del Rosario, School of Medicine and Health Sciences, Bogotá, Colombia. Electronic address: andres.rodriguez@vumc.org. 2. Division of Orthopaedic Trauma, Vanderbilt Medical Center, 1215st Avenue South, Nashville, TN, 37212, United States. Electronic address: basem.a.attum@vumc.org. 3. Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, United States. Electronic address: neokwumabua17@email.mmc.edu. 4. Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, United States. Electronic address: nharrison17@email.mmc.edu. 5. Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, United States. Electronic address: aevans17@email.mmc.edu. 6. Department of Orthopaedics, Vanderbilt Medical Center, 1215 21st Avenue South, Nashville, TN, 37212, United States. Electronic address: jacquelyn.pennings@vanderbilt.edu. 7. Department of Orthopaedics, Vanderbilt Medical Center, 1215 21st Avenue South, Nashville, TN, 37212, United States. Electronic address: bernes.karacay.1@vumc.org. 8. Department of Anesthesiology, Vanderbilt Medical Center, 1215 21st Avenue South, Nashville, TN, 37212, United States. Electronic address: mark.j.rice@vanderbilt.edu. 9. Division of Orthopaedic Trauma, Vanderbilt Medical Center, 1215st Avenue South, Nashville, TN, 37212, United States. Electronic address: william.obremskey@Vanderbilt.edu.
Abstract
OBJECTIVES: Identify a glucose threshold that would put patients with isolated bicondylar tibial plateau fractures at risk of early wound infection (i.e. < 90 days). DESIGN: Retrospective review of medical records. SETTING: Academic American College of Surgeons (ACS) Level 1 trauma center. PATIENTS: Adult patients between 2010 and 2015 with an operatively treated isolated bicondylar tibial plateau fracture and at least three glucose measurements during their hospitalization. MAIN OUTCOME MEASUREMENT: To predict infection using four different methods: maximum preoperative blood glucose (PBG), maximum blood glucose (MGB), Hyperglycemic Index (HGI), and Time-Weighted Average Glucose (TWAG). RESULTS: 126/381 patients met our inclusion criteria. Fifteen (12%) patients had an open fracture and 30/126 (23%) developed an infection. Median glucose for each predictive method studied was 114 (IQR 101.2-137.8) mg/dL for PBG, 144 (IQR 119-169.8) mg/dL for MBG, 0.8 (IQR 0.20-1.60) mmol/L for HGI, and 120.4 (IQR 106.0-135.6) mg/dL for TWAG. As expected, infected patients had higher PBG, MGB, and TWAG. HGI was similar in both groups. None of these differences prove to be statistically significant (p > .05). Logistic regression models for all the methods showed that having an open fracture was the strongest predictor of infection. CONCLUSION: It is well known that stress-induced hyperglycemia increases the risk of infection, we present and compare four models that have been used in other medical fields. In our study, none of the methods presented identified a glucose threshold that would increase the risk of infection in patients with bicondylar tibial plateau fractures. LEVEL OF EVIDENCE: Retrospective review, Level III. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: Identify a glucose threshold that would put patients with isolated bicondylar tibial plateau fractures at risk of early wound infection (i.e. < 90 days). DESIGN: Retrospective review of medical records. SETTING: Academic American College of Surgeons (ACS) Level 1 trauma center. PATIENTS: Adult patients between 2010 and 2015 with an operatively treated isolated bicondylar tibial plateau fracture and at least three glucose measurements during their hospitalization. MAIN OUTCOME MEASUREMENT: To predict infection using four different methods: maximum preoperative blood glucose (PBG), maximum blood glucose (MGB), Hyperglycemic Index (HGI), and Time-Weighted Average Glucose (TWAG). RESULTS: 126/381 patients met our inclusion criteria. Fifteen (12%) patients had an open fracture and 30/126 (23%) developed an infection. Median glucose for each predictive method studied was 114 (IQR 101.2-137.8) mg/dL for PBG, 144 (IQR 119-169.8) mg/dL for MBG, 0.8 (IQR 0.20-1.60) mmol/L for HGI, and 120.4 (IQR 106.0-135.6) mg/dL for TWAG. As expected, infected patients had higher PBG, MGB, and TWAG. HGI was similar in both groups. None of these differences prove to be statistically significant (p > .05). Logistic regression models for all the methods showed that having an open fracture was the strongest predictor of infection. CONCLUSION: It is well known that stress-induced hyperglycemia increases the risk of infection, we present and compare four models that have been used in other medical fields. In our study, none of the methods presented identified a glucose threshold that would increase the risk of infection in patients with bicondylar tibial plateau fractures. LEVEL OF EVIDENCE: Retrospective review, Level III. See Instructions for Authors for a complete description of levels of evidence.
Authors: Jorge A Berlanga-Acosta; Gerardo E Guillén-Nieto; Nadia Rodríguez-Rodríguez; Yssel Mendoza-Mari; Maria Luisa Bringas-Vega; Jorge O Berlanga-Saez; Diana García Del Barco Herrera; Indira Martinez-Jimenez; Sandra Hernandez-Gutierrez; Pedro A Valdés-Sosa Journal: Front Endocrinol (Lausanne) Date: 2020-09-16 Impact factor: 5.555