Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery

Blankush, Joseph M.; Leitman, I. Michael; Soleiman, Aron; Tran, Trung

doi:10.1016/j.amsu.2016.07.025

Cited by 26 publications

(15 citation statements)

References 40 publications

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“…In terms of preoperative glycemic control for postoperative complications and postoperative length of hospital stay, a preoperative HbA1c level < 7.0% is an optimum indicator that can be used in reducing postoperative infectious complications in non-cardiac surgeries [ 26 ]. A chronic hyperglycemic state leads to impaired immune system, which contributes to the increased incidence of postoperative infections [ 26 , 27 ]. However, the results of the present study were not consistent with those of other studies.…”

Section: Discussionmentioning

confidence: 99%

Impact of diabetes mellitus on postoperative outcomes in individuals with non-small-cell lung cancer: A retrospective cohort study

et al. 2020

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Objectives Studies showing that individuals with non-small cell lung cancer (NSCLC) and diabetes mellitus (DM) have reported poor outcomes after pulmonary resection with varying results. Therefore, we investigated the clinical impact of preoperative DM on postoperative morbidity and survival in individuals with resectable NSCLC. Patients and methods Data of individuals who underwent pulmonary resection for NSCLC from 2000 to 2015 were extracted from the database of Kyoto University Hospital. The primary endpoint was the incidence of postoperative complications, and secondary endpoints were postoperative length of hospital stay and overall survival. The survival rate was analyzed using the Kaplan–Meier method. Results A total of 2,219 patients were eligible for the study. The median age of participants was 67 years. Among them, 39.5% were women, and 259 (11.7%) presented with DM. The effect of DM on the incidence of postoperative complications and postoperative length of hospital stay was not significant. Although the 5-year survival rates were similar in both patients with and without DM (80.2% versus 79.4%; p = 0.158), those with DM who had a hemoglobin A1c level ≥ 8.0% had the worst survival. Conclusions In individuals with resectable NSCLC, preoperative DM does not influence the acute phase postoperative recovery. However, poorly controlled preoperative DM could lead to low postoperative survival rates.

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Section: Discussionmentioning

confidence: 99%

Impact of diabetes mellitus on postoperative outcomes in individuals with non-small-cell lung cancer: A retrospective cohort study

et al. 2020

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“…All blood glucose values reported from the day of surgery and for 48 hours after surgery were collated to give a mean value of peri-operative glycemic control. For group analysis of peri-operative glycemic control, a mean value of ≤10 mmol/l was categorized as optimal control and a mean value of >10 mmol/l as sub-optimal control [ 5 ]. The admission glucose value, the maximum glucose value and HbA1c were also separately recorded.…”

Section: Methodsmentioning

confidence: 99%

“…Pre-existing diabetes has been associated with increased risk of post-operative infection [ 2 - 4 ]. Poor control of underlying diabetes, measured as a raised glycosylated hemoglobin A1c (HbA1c) mmol/mol, also increases the risk of infection in some analysis but not all [ 5 , 6 ]. Efforts to better control the peri-operative glucose levels have been shown to decrease the incidence of post-operative infections [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Acute Stress Glycemic Control and Long-Term Glycemic Control on the Incidence of Post-Operative Infection in Diabetics Undergoing Cardiac Surgery

Bennett

Alayesh

Algarni

et al. 2021

Cureus

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Objective Post-operative infection after cardiac surgery causes prolonged hospital stay and increased mortality. In patients with diabetes, peri-operative and pre-operative glycemic control have been associated with increased risk of post-operative infection. Saudi Arabia is the 7th highest country in the world for the prevalence of diabetes. In our surgical population the incidence of diabetes is 77%. We were aware of a high incidence of post-operative infections in our institution. The aim of this work was to assess how peri-operative and pre-operative glycemic control was related to the six-week incidence of post-operative infection. Method We retrospectively collected data for 174 adult patients with diabetes undergoing cardiac surgery between January 2017 and June 2019. For group analysis of peri-operative glycemic control, a mean value of ≤10 mmol/l was categorized as optimal control and a mean value of >10 mmol/l as sub-optimal control. The admission glucose value, the maximum glucose value and glycosylated hemoglobin A1c (HbA1c) were separately recorded. Admission HbA1c was used for optimal long-term control group (HbA1c ≤ 7%) and sub-optimal long-term control group (HbA1c > 7%). Results Of the 174 patients 60 (34%) developed infection in the six-week post-operative period. No statistically significant difference in infections was seen in the optimal peri-operative control group (n = 24, 14%) compared to sub-optimal peri-operative control group (n = 36, 21%; p = 0.113). However, patients with infection had a significantly higher mean glucose (10.4 mmol/l versus 9.9 mmol/l, p = 0.0316) than no infection. Grouping according to their HbA1c: well controlled group (41, 24.0%) and poor control group (130, 76.0%) showed no difference in infections. However, patients with lower HbA1c had better glycemic control as measured by: initial glucose (r = 0.52, p=<0.001); mean peri-operative glucose (r = 0.45, p=<0.001); maximum recorded glucose (r = 0.41, p=<0.001). Conclusion The majority of our patients presented with sub-optimal long-term glycemic control which we linked to poor stress glycemic control perioperatively. Patients with post-operative infections had higher mean peri-operative blood glucose. With the high incidence of diabetes in Saudi Arabia we have demonstrated the importance of good pre-operative assessment which allows tighter peri-operative glycemic control to reduce post-operative morbidity.

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“…Although diabetes status is an independent risk factor for postoperative infections, multiple studies have shown that HbA1c does not correlate with infection, wound healing, or operative complication rate. 10,12,24 Thus, HbA1c may not adequately reveal the adverse effects of hyperglycemia, potentially masking opportunities for beneficial interventions in candidates for elective surgical procedures.…”

Section: Traditional Measures Of Glycemic Controlmentioning

confidence: 99%

“…This may explain the mixed results obtained in studies that have attempted to correlate HbA1c with adverse surgical outcomes. 9–12 Conversely, plasma glucose is simply a snapshot of control that is highly variable. Thus, the search continues for ideal measures of glycemic control.…”

Section: Introductionmentioning

confidence: 99%

An Update on Measures of Preoperative Glycemic Control

Ngaage

Osadebey

Tullie

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Summary: Glycemic control represents a modifiable preoperative risk factor in surgery. Traditionally, hemoglobin A1c (HbA1c) and plasma glucose are utilized as measures of glycemic control. However, studies show mixed results regarding the ability of these conventional measures to predict adverse surgical outcomes. This may be explained by the time window captured by HbA1c and serum glucose: long-term and immediate glycemic control, respectively. Fructosamine, glycosylated albumin, and 1,5-anhydroglucitol constitute alternative metrics of glycemic control that are of growing interest but are underutilized in the field of surgery. These nontraditional measures reflect the temporal variations in glycemia over the preceding days to weeks. Therefore, they may more accurately reflect glycemic control within the time window that most significantly affects surgical outcomes. Additionally, these alternative measures are predictive of negative outcomes, even in the nondiabetic population and in patients with chronic renal disease and anemia, for whom HbA1c performs poorly. Adopting these newer metrics of glycemia may enhance the value of preoperative evaluation, such that the effectiveness of any preoperative glycemic control interventions can be assessed, and adverse outcomes associated with hyperglycemia better predicted. The goal of this review is to provide an update on the preoperative management of glycemia and to describe alternative metrics that may improve our ability to predict and control for the negative outcomes associated with poor glycemic control.

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Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery

Cited by 26 publications

References 40 publications

Impact of diabetes mellitus on postoperative outcomes in individuals with non-small-cell lung cancer: A retrospective cohort study

Impact of diabetes mellitus on postoperative outcomes in individuals with non-small-cell lung cancer: A retrospective cohort study

Effect of Acute Stress Glycemic Control and Long-Term Glycemic Control on the Incidence of Post-Operative Infection in Diabetics Undergoing Cardiac Surgery

An Update on Measures of Preoperative Glycemic Control

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