This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (19)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Surgical Physiology, Other  • Endocrine Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Annika S. Dronge, MD; Melissa F. Perkal, MD; Sue Kancir, RN; John Concato, MD, MPH; Michaela Aslan, PhD; Ronnie A. Rosenthal, MS, MD

Arch Surg. 2006;141:375-380.

Hypothesis  Good preoperative glycemic control (hemoglobin A_1c [HbA_1c] levels <7%) is associated with decreased postoperative infections.

Design  Retrospective observational study using Veterans Affairs National Surgical Quality Improvement Program data from the Veterans Affairs Connecticut Healthcare System from January 1, 2000, through September 30, 2003.

Setting  Veterans Affairs Connecticut Healthcare System, a tertiary referral center and major university teaching site.

Patients  Six hundred forty-seven diabetic patients underwent major noncardiac surgery during the study period; 139 were excluded because the HbA_1c levels were more than 180 days prior to surgery; 19 were excluded for other reasons; 490 diabetic patients were analyzed. The study patients were predominantly nonblack men with a median age of 71 years.

Main Outcome Measures  Primary outcomes were infectious complications, including pneumonia, wound infection, urinary tract infection, or sepsis. Bivariate analysis was used first to determine the association of each independent variable (age, race, diabetic treatment, American Society of Anesthesiologists classification, Activities of Daily Living assessment, elective vs emergent procedure, wound classification, operation length, and HbA_1c levels) with outcome. Factors significant at P<.05 were used in a multivariable logistic regression model.

Results  In the multivariable model, age, American Society of Anesthesiologists class, operation length, wound class, and HbA_1c levels were significantly associated with postoperative infections. Emergency/urgent cases and dependence in Activities of Daily Living were significant in bivariate analysis but failed to reach statistical significance in the multivariable model. An HbA_1c level of less than 7% was significantly associated with decreased infectious complications with an adjusted odds ratio of 2.13 (95% confidence interval, 1.23-3.70) and a P value of .007.

Conclusion  Good preoperative glycemic control (HbA_1c levels <7%) is associated with a decrease in infectious complications across a variety of surgical procedures.

Author Affiliations: VA Connecticut Healthcare System, West Haven (Drs Perkal, Concato, Aslan, and Rosenthal and Ms Kancir); and Surgical Service, Yale University School of Medicine, West Haven (Drs Dronge, Perkal, Concato, Aslan, and Rosenthal and Ms Kancir).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Perioperative management of diabetes: Translating evidence into practice
MENEGHINI
Cleveland Clinic Journal of Medicine 2009;76:S53-S59.
ABSTRACT | FULL TEXT  

Continuous Postoperative Blood Glucose Monitoring and Control by Artificial Pancreas in Patients Having Pancreatic Resection: A Prospective Randomized Clinical Trial
Okabayashi et al.
Arch Surg 2009;144:933-937.
ABSTRACT | FULL TEXT  

The Impact of Glycemic Control and Diabetes Mellitus on Perioperative Outcomes After Total Joint Arthroplasty
Marchant et al.
JBJS 2009;91:1621-1629.
ABSTRACT | FULL TEXT  

Preoperative Hypoglycemia in a Patient Receiving Insulin Detemir
Olson et al.
Anesth. Analg. 2009;108:1836-1838.
ABSTRACT | FULL TEXT