Hyperglycemia as a risk factor for postoperative early wound infection after bicondylar tibial plateau fractures: Determining a predictive model based on four methods

Rodriguez-Buitrago, Andres; Attum, Basem; Okwumabua, Ebubechi; Enata, Nichelle; Evans, Adam; Pennings, Jacquelyn S.; Karacay, Bernes; Rice, Mark J.; Obremskey, William T.

doi:10.1016/j.injury.2019.07.028

Cited by 10 publications

(3 citation statements)

References 20 publications

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“…Recognition of admission BG values as a marker of risk may allow for optimal management by the treating physician and proper resource allocation by the health care system. 45 This in turn would help reduce the excessive morbidity associated with SSI. With that being said, it is important to recognize that recommendations for intense insulin management in these patients is out of the scope of this study, and its effect is unknown.…”

Section: Discussionmentioning

confidence: 99%

Admission Hyperglycemia Is a Risk Factor for Deep Surgical-Site Infection in Orthopaedic Trauma Patients

Anderson

Wise²,

Joshi

et al. 2021

Journal of Orthopaedic Trauma

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orthopaedic trauma patients with an extremity, pelvic, or acetabular fracture and requiring open reduction and internal fixation or intramedullary nailing. Intervention: None. Main Outcome Measurements: Ninety-day deep surgical site infection.Results: Admission blood glucose $200 mg/dL was significantly associated with the primary outcome (8/128, 6.3% vs. 35/337, 1.8%; P = 0.01). Multivariable logistic regression modeling demonstrated that admission blood glucose $200 mg/dL was a significant risk factor for deep surgical site infections [odds ratio (OR): 4.7, 95% confidence interval (CI) 1.4-15.7], after controlling for male gender

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Section: Discussionmentioning

confidence: 99%

Admission Hyperglycemia Is a Risk Factor for Deep Surgical-Site Infection in Orthopaedic Trauma Patients

Anderson

Wise²,

Joshi

et al. 2021

Journal of Orthopaedic Trauma

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show abstract

“…Hyperglycemia which also comprises the oscillation of the “trivial” blood glucose levels, known as hyperglycemia transient spikes, is a major risk factor for a variety of pathologies and clinical and surgical complications ( 61 , 62 ), including poor wound healing and wound infections ( 63 – 65 ). Hyperglycemia is also the proximal trigger for all the downstream molecular derangements in diabetes including cellular senescence ( 66 , 67 ).…”

Section: Diabetes and Cellular Senescence Brief Mechanistic Overviewmentioning

confidence: 99%

Cellular Senescence as the Pathogenic Hub of Diabetes-Related Wound Chronicity

et al. 2020

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Diabetes is constantly increasing at a rate that outpaces genetic variation and approaches to pandemic magnitude. Skin cells physiology and the cutaneous healing response are progressively undermined in diabetes which predisposes to lower limb ulceration, recidivism, and subsequent lower extremities amputation as a frightened complication. The molecular operators whereby diabetes reduces tissues resilience and hampers the repair mechanisms remain elusive. We have accrued the notion that diabetic environment embraces preconditioning factors that definitively propel premature cellular senescence, and that ulcer cells senescence impair the healing response. Hyperglycemia/oxidative stress/mitochondrial and DNA damage may act as major drivers sculpturing the senescent phenotype. We review here historical and recent evidences that substantiate the hypothesis that diabetic foot ulcers healing trajectory, is definitively impinged by a self-expanding and self-perpetuative senescent cells society that drives wound chronicity. This society may be fostered by a diabetic archetypal secretome that induces replicative senescence in dermal fibroblasts, endothelial cells, and keratinocytes. Mesenchymal stem cells are also susceptible to major diabetic senescence drivers, which accounts for the inability of these cells to appropriately assist in diabetics wound healing. Thus, the use of autologous stem cells has not translated in significant clinical outcomes. Novel and multifaceted therapeutic approaches are required to pharmacologically mitigate the diabetic cellular senescence operators and reduce the secondary multi-organs complications. The senescent cells society and its adjunctive secretome could be an ideal local target to manipulate diabetic ulcers and prevent wound chronification and acute recidivism. This futuristic goal demands harnessing the diabetic wound chronicity epigenomic signature.

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“…1 The rates of SSI in tibial plafond and tibial plateau fractures undergoing open reduction and internal fixation (ORIF) may be as high as 13.8%-24.2%. [2][3][4][5][6] Specifically, OTA/AO 7 type 41C and 43C fractures are associated with increased rates of SSI compared with type A and type B fractures. 4 Various studies have also identified several risk factors to be associated with SSI in orthopaedic fracture surgery.…”

Section: Introductionmentioning

confidence: 99%

How Can Negative Pressure Wound Therapy Pay for Itself?—Reducing Complications Is Important

Zelle

Kore

2022

Journal of Orthopaedic Trauma

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Introduction: Orthopaedic trauma demonstrates a relatively high rate of surgical site infections (SSI) as compared with other surgical specialties. SSIs provide significant clinical challenges and create significant health care costs. Incisional negative pressure wound therapy (iNPWT) has reduced the risk of SSI in orthopaedic surgery and other surgical specialties. Purpose:The purpose of this study is to investigate potential cost savings with the use of iNPWT (3M Prevena Therapy, 3M, St. Paul, MN) in high-risk orthopaedic trauma patients with closed OTA/AO 41C and 43C fractures.Methods: This is a retrospective cohort study performed at a single, level-1 trauma center using data from a lower extremity fracture registry. Using the results from the registry and baseline infection rates derived from the literature, a health economic model was developed to evaluate the potential cost savings.Results: A total of 79 patients included in the registry underwent open reduction and internal fixation of OTA/AO 41C and 43C fractures. A total of 10.1% developed a SSI. For those who received iNPWT, the rate of SSI was 7.4%. A health economic model suggests that the use of iNPWT may reduce the costs per patient by approximately $1381 to $4436 per patient. Conclusions:This health economic assessment and model suggests that judicious use of iNPWT may reduce health care costs in patients undergoing open reduction and internal fixation of OTA/AO 41C and 43C fractures.

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Hyperglycemia as a risk factor for postoperative early wound infection after bicondylar tibial plateau fractures: Determining a predictive model based on four methods

Cited by 10 publications

References 20 publications

Admission Hyperglycemia Is a Risk Factor for Deep Surgical-Site Infection in Orthopaedic Trauma Patients

Admission Hyperglycemia Is a Risk Factor for Deep Surgical-Site Infection in Orthopaedic Trauma Patients

Cellular Senescence as the Pathogenic Hub of Diabetes-Related Wound Chronicity

How Can Negative Pressure Wound Therapy Pay for Itself?—Reducing Complications Is Important

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