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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31829fe119
Reconstructive: Lower Extremity: Original Articles

The Role of Chronic and Perioperative Glucose Management in High-Risk Surgical Closures: A Case for Tighter Glycemic Control

Endara, Matthew M.D.; Masden, Derek M.D.; Goldstein, Jesse M.D.; Gondek, Stephen M.D., M.P.H.; Steinberg, John D.P.M.; Attinger, Christopher M.D.

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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.

©2013American Society of Plastic Surgeons

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