Among patients undergoing surgery for chronic wounds related to diabetes, poor glycemic control was significantly associated with worse outcomes, according to recent study results. Good control of glucose levels before surgery is important for diabetic patients at high risk of wound complications.
Researchers evaluated the effects of chronic and perioperative glucose control in 79 high-risk patients undergoing surgical wound closure. Five days before and after surgical closure, researchers recorded hemoglobin A1c and blood glucose levels and compared them with the primary endpoints of dehiscence, infection and reoperation.
Study results showed a significant association between preoperative and postoperative hyperglycemia and elevated A1c levels with increased rates of dehiscence. Patients with a range of glucose levels exceeding 200 points had increased rates of reoperation and experienced increased rates of dehiscence, according to study results. Multivariate regression analysis showed only perioperative hyperglycemia and elevated A1c levels to be significantly associated with increased rates of dehiscence.
“Further work is needed to determine the best approach to reaching these goals in this difficult patient population,” the researchers concluded. “At the minimum, however, we have provided information the surgeon can present to patients contemplating wound closure in the setting of suboptimal glucose management.”
For more information:
Endara M. Plast Reconstr Surg. 2013;132:996-1004.
Disclosure: Attinger reports being a consultant for KCI.