SLR - June 2010 - Adam J. Peaden

Long-term glucose control and risk of perioperative complications

Reference
Acott, A., Theus, S., and Kim, L.  Long-term glucose control and risk of perioperative complications.  Am J Surg 2009; 198:596-599.

Scientific Literature Reviews

Reviewed by:  Adam J. Peaden, DPM
Residency Program: Florida Hospital East Orlando

Podiatric Relevance:
It has long been recognized that diabetic patients have many complications relating to hyperglycemia, including imparied wound healing, which is of utmost concern for the podiatric surgeon.  The impact of long-term glucose control ,which is measured by the hemoglobin A1c, remains unclear and is examined in this study.

Methods:
The South Central Veterans Administration Healthcare Network data warehouse was used to identify 38,989 patients who had HbA1c levels drawn within 30 days of surgery and underwent surgery involving at least 1 skin incision .  Data collected included ASA class, gender, and surgical procedure performed.  ICD codes from the database were searched including skin and soft tissue infections, renal insufficiency, acute renal failure, UTI, pneumonia, PE, CVA, heart failure, MI, DVT, sepsis, postoperative complications, and mortality. 

Results: 
Of the 2,960 diabetic patients identified in this study, 26.4% (780/2960) had 1 or more complications, and this was found to be a significant difference in comparison to the nondiabetic population which had a complication rate of 14.1%.   The mean HbA1c level of diabetics having complications was 7.0 compared to the mean HbA1c of those with no complications being 7.1, an insignificant finding.  When HbA1c was divided into 1 point increments  (i.e. 6.0-6.9, 7.0 - 7.9, etc) and then compared to the group of patients with HbA1c less than 6.0, there was no difference in complications in any single group.  There was also no difference in mortality rates.

Conclusions:
While this study showed no evidence to support a connection between high HbA1c levels and poor surgical outcomes or complications, the study did reveal a significant difference in complication rates between those with diabetes and those without.  These results suggest that long-term glucose control may not have a significant impact on short-term surgical morbidity, but the overall impact of diabetes in general is significant.

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