Matthew Endara1, Derek Masden, Jesse Goldstein, Stephen Gondek, John Steinberg, Christopher Attinger. 1. Washington, D.C.; Baltimore, Md.; Philadelphia, Pa.; and Boston, Mass. From the Center for Wound Healing, Department of Plastic Surgery, Georgetown University Hospital; Department of Hand Surgery, Union Memorial Hospital; Department of Plastic Surgery, Children's Hospital of Philadelphia; and Department of Surgery, Beth Israel Deaconess Medical Center.
Abstract
BACKGROUND: The exact risk that poor glucose control introduces to patients undergoing surgical closure has yet to be fully defined. METHODS: The authors retrospectively analyzed a prospectively collected database of patients seen at their wound care center to evaluate the effects of chronic and perioperative glucose control in high-risk patients undergoing surgical wound closure. Hemoglobin A1c and blood glucose levels for the 5 days before and after surgical closure were recorded and compared with the primary endpoints of dehiscence, infection, and reoperation. Univariate and multivariate analyses were performed. RESULTS: Seventy-nine patients had perioperative glucose levels and 64 had hemoglobin A1C levels available for analysis. Preoperative and postoperative hyperglycemia (defined as any blood glucose measurement above 200 mg/dl) as well as elevated A1C levels (above 6.5 percent or 48 mmol/ml) were significantly associated with increased rates of dehiscence (odds ratio, 3.2, p = 0.048; odds ratio, 3.46, p = 0.028; and odds ratio, 3.54, p = 0.040, respectively). Variability in preoperative glucose (defined as a range of glucose levels exceeding 200 points) was significantly associated with increased rates of reoperation (odds ratio, 4.14, p = 0.025) and trended toward significance with increased rates of dehiscence (p = 0.15). In multivariate regression, only perioperative hyperglycemia and elevated A1c were significantly associated with increased rates of dehiscence. CONCLUSIONS: In primary closure of surgical wounds in high-risk patients, poor glycemic control is significantly associated with worse outcomes. Every effort should be made to ensure tight control in both the chronic and subacute perioperative periods. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
BACKGROUND: The exact risk that poor glucose control introduces to patients undergoing surgical closure has yet to be fully defined. METHODS: The authors retrospectively analyzed a prospectively collected database of patients seen at their wound care center to evaluate the effects of chronic and perioperative glucose control in high-risk patients undergoing surgical wound closure. Hemoglobin A1c and blood glucose levels for the 5 days before and after surgical closure were recorded and compared with the primary endpoints of dehiscence, infection, and reoperation. Univariate and multivariate analyses were performed. RESULTS: Seventy-nine patients had perioperative glucose levels and 64 had hemoglobin A1C levels available for analysis. Preoperative and postoperative hyperglycemia (defined as any blood glucose measurement above 200 mg/dl) as well as elevated A1C levels (above 6.5 percent or 48 mmol/ml) were significantly associated with increased rates of dehiscence (odds ratio, 3.2, p = 0.048; odds ratio, 3.46, p = 0.028; and odds ratio, 3.54, p = 0.040, respectively). Variability in preoperative glucose (defined as a range of glucose levels exceeding 200 points) was significantly associated with increased rates of reoperation (odds ratio, 4.14, p = 0.025) and trended toward significance with increased rates of dehiscence (p = 0.15). In multivariate regression, only perioperative hyperglycemia and elevated A1c were significantly associated with increased rates of dehiscence. CONCLUSIONS: In primary closure of surgical wounds in high-risk patients, poor glycemic control is significantly associated with worse outcomes. Every effort should be made to ensure tight control in both the chronic and subacute perioperative periods. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
Authors: Kaspar Trocha; Peter Kip; Michael R MacArthur; Sarah J Mitchell; Alban Longchamp; Jose Humberto Treviño-Villarreal; Ming Tao; Miriam A Bredella; Karen De Amorim Bernstein; James R Mitchell; Charles Keith Ozaki Journal: J Surg Res Date: 2018-11-17 Impact factor: 2.192
Authors: Austin P Seaman; Kathryn A Schlosser; Daniel Eiferman; Vimal Narula; Benjamin K Poulose; Jeffrey E Janis Journal: J Gastrointest Surg Date: 2022-01-10 Impact factor: 3.267