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升高的Hb A1C水平和修订性减肥手术并发症
Mahnoor Zia1, Therese Hoof1, Jiaqiong Susan Xu2
1Department of Surgery, Houston Methodist Hospital, Houston, Texas.
概括
升高的血红蛋白A1C (HbA1C) 水平并没有增加修复性减肥手术患者的术后并发症. 这一发现表明,HbA1C值在这个特定的手术患者群体中可能并不那么关键.
科学领域:
- 代谢和腹部手术 代谢和腹部手术
- 手术结果研究研究.
- 在手术患者的糖尿病管理.
背景情况:
- 血红蛋白A1C (HbA1C) 升高是术后并发症的已知危险因素.
- 之前对HbA1C和减肥手术结果的研究主要集中在初级手术上.
- 升高的HbA1C对高风险修订性减肥手术队列的结果的影响仍未得到充分研究.
研究的目的:
- 评估手术前HbA1C水平升高与手术后早期并发症之间的关联,在接受修复性减肥手术的患者中.
- 确定特定的HbA1C值 (≤8%和≤10%) 是否可预测该患者组的不良结果.
主要方法:
- 对代谢和腹部外科认证和质量改善计划 (MBSAQIP) 数据库 (2017-2018) 的回顾性分析.
- 包括接受修复性减肥手术的患者.
- 使用倾向性得分匹配 (PSM) 来比较HbA1C组之间的并发症率 (≤8% vs. >8%和≤10% vs. >10%).
主要成果:
- 总共分析了16234名患者.
- 在PSM后,在HbA1C组之间没有观察到所有并发症的综合结果的显著差异 (P = .22为≤8%与>8%;P < .46为≤10%与>10%).
- 个体并发症率,包括手术部位感染,心肺问题和再接收/重新干预,在HbA1C值之间相似.
结论:
- 术前升高的HbA1C水平 (>8%或>10%) 与接受修复性减肥手术的患者早期术后并发症的增加无关.
- 这些发现挑战了对HbA1C的传统理解,认为HbA1C是这种特定人群中手术风险的普遍预测因素.
- 需要进一步的前性研究来证实这些结果并完善风险分层策略.
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