The role of chronic and perioperative glucose management in high-risk surgical closures: a case for tighter glycemic control.
The role of chronic and perioperative glucose management in high-risk surgical closures: a case for tighter glycemic control.
- 2013
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.
English
0032-1052
*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 Techniques
Curtis National Hand Center
Journal Article
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.
English
0032-1052
*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 Techniques
Curtis National Hand Center
Journal Article