The association between hemoglobin A1C values and deep sternal wound infections in diabetes patients undergoing cardiac surgery

Fohl, Alexander L.; Butler, Simona; Patil, Preethi; Zrull, Christina A.; Kling-Colson, Sue; DuBois, Elizabeth C.; Sweeney, Jennifer; Haft, Jonathan W.; Gianchandani, Roma

doi:10.1097/xce.0b013e32835eca16

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Fohl and co-workerexamined the relationship between HbA1c% and DSWI in 861 diabetic cardiac surgery patients whose postoperative blood glucose was maintained between 100-140 mg/dL. Preoperative HbA1c levels of > 8.5 was found to be associated with an increased incidence of DSWI [13] . HbA1c% proved to be a powerful predictor of in-hospital mortality and morbidity postoperatively including Significant increase in DSWI in a study conducted by Halkos and associateson3089 diabetic and non-diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

The relationship between elevated HbA1c% and surgical site infection in patients undergoing CABG

2018

Zagazig University Medical Journal

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Objective: Controversy still exists whether adequacy ofpreoperative diabetes control measured by HbA1c% is a predictor of elevated incidence of surgical site infection (SSI) after CABG. Methods:prospective study was done on 48 diabetic patients underwent CABG surgery. They were classified into 2 groups, Group (A):24 patients with fair glycemic control (HbA1c isunder or equal to 7%), Group (B): 24 patients with poor glycemic control (HbA1c above 7%). SSI either sternotomy or saphenous wound infection were studied in both groups. Results: Superficial wound infection for group A was 12.5% and 25% for group B with significant statistical differenceamong the two groups. Deep Sternal Wound Infection (DSWI) was (4.1%) group A and group B with no statistical significance.As regard Saphenous wound infection was (8.3%) for groupA and (25%) for group B with statistical difference, also group B has higher frequency of hospital readmission and need inotropes more than groupA. Conclusions: Elevated HbA1c >7 in patients undergoing CABG associated with increasedfrequency of SWI and saphenous harvesting site infection but there was no significant increase in DSWI.Patients with elevated HbA1c >7 has more resistant peri-operative control of RBS. Finally we found that good peri-operative control of RBS associated with decreased rate of SSI after CABG. HbA1c is simple test that may offer the surgeon with better risk profile assessment and give additional prognostic data when discussing morbidity and mortality risks with patients and their relatives.

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Section: Discussionmentioning

confidence: 99%

The relationship between elevated HbA1c% and surgical site infection in patients undergoing CABG

2018

Zagazig University Medical Journal

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“…Our fi ndings are contradictory to those of some reports. Fohl et al examined the relationship between HbA1c and DSWI in 861 cardiac surgery patients with DM whose postoperative blood glucose was maintained between 100-140 mg/dL (30) . Preoperative HbA1c levels of > 8.5 was found to be associated with an increased incidence of DSWI.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Elevated HbA1c and Deep Sternal Wound Infection in Patients Undergoing Cardiac Surgery

Sevük¹,

Bilgiç²,

Yaylak³

et al. 2016

Kosuyolu Heart Journal

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Introduction: Hyperglycemia is common in patients with and without diabetes mellitus (DM) following cardiac surgery. Intra-and postoperative hyperglycemia has been shown to be an independent risk factor for deep sternal wound infection (DSWI) after cardiac surgery. However, whether the preoperative chronic glycemic control is associated with the risk of DSWI remains controversial. Hemoglobin A1c (HbA1c) provides a measure of glucose control over the prior 2-3 months. The aim of this study was to evaluate the relationship between preoperative HbA1c levels and DSWI in patients with DM undergoing coronary artery bypass grafting (CABG). Patients and Methods:Records of patients who underwent elective on-pump CABG were retrospectively reviewed. A total of 180 patients with DM were included in the study. Patients were excluded if their blood glucose levels were not adequately controlled in the perioperative period. A total of 200 consecutive patients without DM were taken as controls.Results: Median HbA1c levels were signifi cantly higher in patients with DM [8.16 (7.2-10.4)] than in controls [5.49 (5-6)] (p< 0.001). There was no signifi cant difference in DSWI incidence between patients with DM and controls [5% (n= 9) vs. 2% (n= 4); P= 0.1]. Hospital (p= 0.01) and intensive care unit stays (p= 0.005) were signifi cantly longer in patients with DM. Conclusion:We found that DSWI was not associated with preoperative HbA1c levels in patients undergoing CABG. In addition, with adequate glycemic control in the perioperative period, our study demonstrated no signifi cant difference with regard to DSWI between patients with DM and controls.Key Words: Mediastinitis; coronary artery bypass grafting; hemoglobin A1c; diabetes mellitus; deep sternal wound infection Kalp Cerrahisi Yapılan Hastalarda Derin Sternal Yara İnfeksiyonları ile HbA1c Seviyeleri Arasındaki İlişki ÖZETGiriş: Kalp cerrahisi yapılan hastalarda, diabetes mellitus (DM)'lu hastalarda olduğu kadar diyabetik olmayan hastalarda da hiperglisemi ile sık karşılaşılır. Kalp cerrahisi sonrasında intraoperatif ve postoperatif hipergliseminin derin sternal yara infeksiyonu (DSYİ) için bağımsız risk faktörü olduğu gösterilmiştir. Ancak, preoperatif kronik glisemik kontrolün DSYİ ile ilişkisi tartışmalıdır. Hemoglobin A1c (HbA1c) geçmiş 2-3 aylık dönemdeki glukoz düzeyi hakkında bilgi verir. Bu çalışmanın amacı koroner baypas cerrahisi yapılan DM'li hastalarda, HbA1c seviyeleri ile DSYİ arasındaki ilişkiyi incelemektir. Hastalar ve Yöntem:Kliniğimizde kardiyopulmoner baypas altında koroner baypas operasyonu yapılmış olan hastaların kayıtları retrospektif olarak incelendi. DM'si olan ve perioperatif periyodda yeterli glisemik kontrol sağlanmış 180 hasta çalışmaya dahil edildi. DM'si olmayan koroner baypas cerrahisi yapılmış ardışık 200 hasta kontrol grubuna dahil edildi. Bulgular: Medyan HbA1c değerleri diyabetik hasta grubunda anlamlı olarak daha yüksekti [8.16 (7.2-10.4 vs 5.49 (5-6), p< 0.001]. DSYİ sıklığı bakımdan iki grup arasında istatistiksel olarak anlamlı b...

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Effect of Preoperative Diabetes Management on Glycemic Control and Clinical Outcomes After Elective Surgery

et al. 2018

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The association between hemoglobin A1C values and deep sternal wound infections in diabetes patients undergoing cardiac surgery

Cited by 3 publications

References 32 publications

The relationship between elevated HbA1c% and surgical site infection in patients undergoing CABG

The relationship between elevated HbA1c% and surgical site infection in patients undergoing CABG

Relationship Between Elevated HbA1c and Deep Sternal Wound Infection in Patients Undergoing Cardiac Surgery

Effect of Preoperative Diabetes Management on Glycemic Control and Clinical Outcomes After Elective Surgery

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