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Glycemic Control Cuts Postoperative Infection in Diabetics

Posted: Thursday, April 27, 2006

Glycosylated hemoglobin (HbA1c) levels less than 7% prior to surgery are associated with a significantly lower rate of postoperative infections in diabetic patients.

Dr. Ronnie A. Rosenthal of the Veterans Affairs Connecticut Healthcare System, West Haven and colleagues retrospectively reviewed outcomes for all diabetic patients who underwent major noncardiac surgery at that center, between 2000 and 2003. The patients' HbA1c levels had been documented within 180 days prior to surgery.

Involved were 490 patients, whose HbA1c level ranged between 4.6% and 15.5%. Postoperative infections -- pneumonia, wound infection, urinary tract infection or sepsis --occurred in 12% of those with HbA1c levels below 7% and in 20% of those with higher levels.

In multiple logistic regression analysis adjusting for age, American Society of Anesthesiologists class, wound class (clean or unclean), and operation length, HbA1c level remained a significant predictor of infectious complications (adjusted odds ratio 2.13, p = 0.007).

One mechanism underlying the improved outcomes may be that lower preoperative HbA1c levels lead to better postoperative glucose control, the authors suggest. Another possibility, they indicate, is that well controlled patients have overall improved health and a better "metabolic milieu."

Should these findings be replicated, Dr. Rosenthal's group concludes, "strategies to improve glycemic control prior to elective surgery can be employed to decrease infections and improve overall outcomes for diabetic surgical patients."

Source: Diabetes In Control: Arch Surg 2006:141:375-380