Hyperglycemia as a risk factor for postoperative early wound infection after bicondylar tibial plateau fractures: Determining a predictive model based on four methods |
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| Affiliation: | 1. Division of Orthopaedic Trauma, Vanderbilt Medical Center, 1215st Avenue South, Nashville, TN, 37212, United States;2. Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, United States;3. Department of Orthopaedics, Vanderbilt Medical Center, 1215 21st Avenue South, Nashville, TN, 37212, United States;4. Department of Anesthesiology, Vanderbilt Medical Center, 1215 21st Avenue South, Nashville, TN, 37212, United States;5. Universidad del Rosario, School of Medicine and Health Sciences, Bogotá, Colombia;1. Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States;2. Department of Epidemiology, Dartmouth College, Hanover, NH, United States;3. Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH, United States;1. London Health Sciences Center, Canada;2. University of Southern California, United States;1. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway;2. Department of Clinical Medicine, University of Bergen, Bergen, Norway;1. Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea;2. Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Republic of Korea |
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| Abstract: | ObjectivesIdentify a glucose threshold that would put patients with isolated bicondylar tibial plateau fractures at risk of early wound infection (i.e. < 90 days).DesignRetrospective review of medical records.SettingAcademic American College of Surgeons (ACS) Level 1 trauma center.PatientsAdult 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 MeasurementTo predict infection using four different methods: maximum preoperative blood glucose (PBG), maximum blood glucose (MGB), Hyperglycemic Index (HGI), and Time-Weighted Average Glucose (TWAG).Results126/381 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.ConclusionIt 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. |
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| Keywords: | Orthopaedic trauma Tibial plateau fractures Infection Surgical site infection Hyperglycemia |
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