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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.

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

In Brief

Video Discussion by Raffi Gurunluoglu, M.D., is Available Online for this Article.

Author Information

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.

Received for publication February 28, 2013; accepted April 8, 2013.

Presented at the Northeastern Society of Plastic Surgeons 29th Annual Meeting, in Boston, Massachusetts, September 27 through 29, 2012; and at Plastic Surgery: The Meeting 2012, the Annual Meeting of the American Society of Plastic Surgeons, in New Orleans, Louisiana, October 26 through 30, 2012.

Disclosure: Dr. Attinger is a consultant for KCI. None of the remaining authors has a financial interest to declare. No additional sources of funding were used to support the work presented in this article.

Christopher Attinger, M.D., Center for Wound Healing, Department of Plastic Surgery, Georgetown University Hospital, Washington, D.C. 20007, cattinger@aol.com

©2013American Society of Plastic Surgeons