Relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait.
OBJECTIVE
To study the relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait.


METHODS
Patients who underwent surgical orthopedic procedures between 2006 and 2007 were identified to provide demographic and clinical informations including age, gender, type of surgery, length of operation, HbA(1c) values, nature of specimens and species of the isolated pathogens. HbA(1c) <7% was used as the breaking point for diabetic control and occurrence of postoperative complications. Primary outcomes with infectious complications, including urinary tract infection, surgical site infection (SSI), lower respiratory tract infection and sepsis with different isolated pathogens were identified at least 48 h postoperatively.


RESULTS
Of 318 diabetic patients who underwent surgical operations, 90 (28.3%) developed postoperative complications; HbA(1c) <7% was significantly associated with decreased infectious complications with an adjusted odds ratio of 2.51 (95% confidence interval, 1.20-2.89). Regarding types of complications, urinary tract infectious complications were significantly higher among those patients with HbA(1c) > or =7% (p < 0.0001), while other complications (SSI, lower respiratory tract infection and sepsis) showed nonsignificant differences (p > 0.05).


CONCLUSIONS
Our study confirmed a close association between preoperative glucose control indicated by HbA(1c) levels <7% and a decreased risk of postoperative infectious complications. Ideally, preoperative blood sugar should be controlled prior to elective surgery. Prophylaxis by antibiotics with preoperative patient preparation, proficient surgical technique and postoperative wound care is recommended for uncontrolled diabetics subjected to surgery.
Lamloum
S M
SM
Department of Laboratory Medicine, Al Razi Hospital, Ministry of Health, Safat 4235, Kuwait. saharlamlom@yahoo.com
Mobasher
L A
LA
Karar
A H
AH
Basiony
L
L
Abdallah
T H
TH
Al-Saleh
A I
AI
Al-Shamali
N A
NA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003428:Cross Infection / Q000209:etiology*; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007730:Kuwait; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D055815:Young Adult
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human