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

Plast Reconstr Surg. 2013 Oct;132(4):996-1004. doi: 10.1097/PRS.0b013e31829fe119.

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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism*
  • Chronic Disease
  • Comorbidity
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / epidemiology
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hyperglycemia / drug therapy*
  • Hyperglycemia / epidemiology
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Middle Aged
  • Perioperative Care / methods*
  • Retrospective Studies
  • Risk Factors
  • Skin Ulcer / surgery*
  • Surgical Wound Dehiscence / epidemiology
  • Surgical Wound Dehiscence / metabolism*
  • Wound Closure Techniques

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human