The role of chronic and perioperative glucose management in high-risk surgical closures: a case for tighter glycemic control.

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Citation: Plastic & Reconstructive Surgery. 132(4):996-1004, 2013 Oct.PMID: 23783058Institution: Curtis National Hand CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Blood Glucose/me [Metabolism] | *Hyperglycemia/dt [Drug Therapy] | *Hypoglycemic Agents/tu [Therapeutic Use] | *Perioperative Care/mt [Methods] | *Skin Ulcer/su [Surgery] | *Surgical Wound Dehiscence/me [Metabolism] | Adult | Aged | Aged, 80 and over | Chronic Disease | Comorbidity | Diabetes Mellitus/dt [Drug Therapy] | Diabetes Mellitus/ep [Epidemiology] | Female | Hemoglobin A, Glycosylated/me [Metabolism] | Humans | Hyperglycemia/ep [Epidemiology] | Male | Middle Aged | Retrospective Studies | Risk Factors | Surgical Wound Dehiscence/ep [Epidemiology] | Wound Closure TechniquesYear: 2013ISSN:
  • 0032-1052
Name of journal: Plastic and reconstructive surgeryAbstract: BACKGROUND: The exact risk that poor glucose control introduces to patients undergoing surgical closure has yet to be fully defined.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.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.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.All authors: Attinger C, Endara M, Goldstein J, Gondek S, Masden D, Steinberg JFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2016-07-15
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Journal Article MedStar Authors Catalog Article 23783058 Available 23783058

BACKGROUND: The exact risk that poor glucose control introduces to patients undergoing surgical closure has yet to be fully defined.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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.

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.

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