Comparison of healing of surgical wounds between diabetics and non-diabetics.
In spite of a strong physiological rationale, diabetes mellitus as a factor causing increased incidence of wound complications in surgical wounds is not entirely supported by literature. How tight should be the peri-operative blood glucose control remains a controversy. This study describes the experience in patients with clean and clean contaminated surgical wounds admitted in this hospital. A prospective observational study included data of 489 patients with clean and clean-contaminated surgical wounds collected serially on randomly assigned days. The data included available factors associated with wound healing along with the diabetic and non-diabetic status of the patients. It also included the blood glucose values in peri- operative period, available values in the recent past, and the duration for which diabetes was known, in diabetic patients. The study attempted to find a relation between these factors and affected wound healing, which was monitored on the 3rd day, suture removal day and one month from the surgery. Out of 489 patients, 95 (19.4%) were diabetics and 394 (80.6%) nondiabetics. Complications were seen in 36 patients (7.4%). Ten (10.5%) out of 95 diabetics suffered complications while 26 (6.6%) of the 394 non-diabetics suffered complications. This 1.7 times increased risk in diabetics was statistically not significant (p > 0.1). In non-diabetic patients, 16 patients with a BMI of less than 18 kg/m2 had complicated wounds against 186 in those having a BMI of 18-25 kg/m2 (p = 0.087). In diabetic patients, 18 patients with a leucocytosis more than 11000/cmm had affected wound healing, as against 77 in those with a total leucocyte count less that 11000/cmm (p = 0.086). As against this, in non-diabetics, 52 patients with total leucocyte count more than 11000/cmm had complications against 342 with a count below 11000/cmm (p > 0.1). In the whole group, 10% of patients with wound at a location other than a joint had complications, as against 2% in those with a wound on a joint (p = 0.041). No association could be obtained between mean peri-operative random blood glucose levels; maximum blood glucose level on first postoperative day; mean postprandial blood glucose in the recent past; duration of diabetes and increased incidence of affected wounds.
Mangrulkar
Sanjeev
S
Department of Medicine, Deenanath Mangeshkar Hospital, Pune.
Khair
Pushkar S
PS
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000276:immunology* / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D014945:Wound Healing / Q000502:physiology*
D001786:Blood Glucose