Perioperative Glycemic Control and the Effect on Surgical Site Infections in Diabetic Patients Undergoing Foot and Ankle Surgery

Sadoskas, David; Suder, Natalie C.; Wukich, Dane K.

doi:10.1177/1938640015593077

Cited by 29 publications

(14 citation statements)

References 19 publications

(33 reference statements)

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“…The number of adults with diabetes has risen significantly from 4.7% in 1980 to 8.5% in 2014 and the figure is continued to continue rising in the next few decades . Whilst most of the sequelae from persistently high blood glucose (such as renal damage, vascular disease, heart disease, stroke and retinal disease) occur slowly over time, a high blood sugar in the perioperative period has been attributed to a variety of postoperative complications, particularly Surgical Site Infections (SSI) and sepsis . A meta‐analysis of 428 studies, involving 866,427 procedures demonstrated diabetic patients to have a more than 50% higher risk of SSI compared to non‐diabetic patients …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the prevalence of DM is predicted to rise by 50% over the next decade . Poor perioperative glucose control has been associated with adverse outcomes and higher complication rates in almost every surgical speciality . Consequently, the Joint British Diabetes Societies for Inpatient Care (JBDS‐IP) developed guidelines for the perioperative management of DM.…”

Section: Introductionmentioning

confidence: 99%

“…1,4 Poor perioperative glucose control has been associated with adverse outcomes and higher complication rates in almost every surgical speciality. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Consequently, the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) 19 developed guidelines for the perioperative management of DM.…”

Section: Introductionmentioning

confidence: 99%

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Diabetes in day case general and vascular surgery: A multicentre regional audit

et al. 2020

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Summary Background People with Diabetes Mellitus (DM) are at increased risk of postoperative complications if their HbA1C readings are not well controlled. In the UK, there are clear national guidelines requiring all people with DM to have HbA1C blood testing within 6months before undergoing surgery and that these readings should be below 69 mmol/mol if this is safe to achieve. The aim of this study was to determine whether hospitals in the region were compliant with the guidelines. Methods Data were prospectively collected from seven hospitals across the East of England region from 1st October 2017 to 31st March 2018 (6 months) in all people with DM undergoing elective day case procedures in General and Vascular surgery for benign disease. Results A total of 181 people with DM were included in the study, of whom 77.9% were male patients and the median age was 63 years. The three most commonly performed operations were laparoscopic cholecystectomy (20.9%, n = 38/181), inguinal hernia repair (20.4%, n = 37/181) and umbilical/para‐umbilical hernia repair (11.0%, n = 20/181). In keeping with the national guidelines, only 86.7% (n = 157/181) of patients had an HbA1C tested within 6 months prior to their surgery date. Of the patients who had a preoperative HbA1C, 14 (n = 14/157, 8.9%) had an HbA1C ≥ 69 mmol/mol, and 12 (n = 12/14, 85.7%) of these proceeded to surgery without optimisation of their HbA1C. Conclusion A significant proportion of people with diabetes undergoing elective day case procedures in our region do not have HbA1C testing within 6 months of their procedure as recommended by the national guidelines. In patients who do have a high HbA1C, the majority still undergo surgery without adequate control of their DM. Greater awareness amongst healthcare workers and robust pathways are required for this vulnerable group of patients if we are to reduce the risk of developing postoperative complication rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diabetes in day case general and vascular surgery: A multicentre regional audit

et al. 2020

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“…We recognize that several studies have demonstrated an increased occurrence of SSIs associated with high preoperative serum glucose levels (111,(156)(157)(158) but concluded that high serum glucose levels on the day of surgery might primarily be a confounder for poor longterm glycemic control. Therefore, one should understand that although the perioperative glucose level is unstable, sensitive, and easily affected by many factors on the day of surgery, it should primarily raise a concern regarding the patient's long-term glucose control and other underlying medical conditions.…”

Section: Preoperative Considerationsmentioning

confidence: 99%

American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

Meyr

Mirmiran

Naldo

et al. 2017

The Journal of Foot and Ankle Surgery

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A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.

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“…Despite numerous studies into the effect of A1C and hyperglycemia on postoperative outcomes (21,22), most consider hyperglycemia alone (1,(23)(24)(25)(26) or A1C alone (13,20,27). When studied together, they are most often not in a multivariable analysis (28,29) in which one can assess the effect of an indicator while controlling for another. Such analysis is pertinent when considering A1C and glucose because they are correlated.…”

mentioning

confidence: 99%

Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries

et al. 2018

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Although A1C is positively associated with perioperative glucose, it is not associated with increased 30-day mortality after controlling for glucose. Perioperative glucose predicts 30-day mortality, linearly in noncardiac and nonlinearly in cardiac procedures. This confirms that perioperative glucose control is related to surgical outcomes but that A1C, reflecting antecedent glycemia, is a less useful predictor.

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Perioperative Glycemic Control and the Effect on Surgical Site Infections in Diabetic Patients Undergoing Foot and Ankle Surgery

Abstract: Prognostic, Level III: Case Control.

Cited by 29 publications

References 19 publications

Diabetes in day case general and vascular surgery: A multicentre regional audit

Diabetes in day case general and vascular surgery: A multicentre regional audit

American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries

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