title: The role of chronic and perioperative glucose management in high-risk surgical closures: a case for tighter glycemic control.
abstract: BACKGROUND
  The exact risk that poor glucose control introduces to patients undergoing surgical closure has yet to be fully defined.
  
  
  METHODS
  The authors retrospectively analyzed a prospectively collected database of patients seen at their wound care center to evaluate the effects of chronic and perioperative glucose control in high-risk patients undergoing surgical wound closure. Hemoglobin A1c and blood glucose levels for the 5 days before and after surgical closure were recorded and compared with the primary endpoints of dehiscence, infection, and reoperation. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Seventy-nine patients had perioperative glucose levels and 64 had hemoglobin A1C levels available for analysis. Preoperative and postoperative hyperglycemia (defined as any blood glucose measurement above 200 mg/dl) as well as elevated A1C levels (above 6.5 percent or 48 mmol/ml) were significantly associated with increased rates of dehiscence (odds ratio, 3.2, p = 0.048; odds ratio, 3.46, p = 0.028; and odds ratio, 3.54, p = 0.040, respectively). Variability in preoperative glucose (defined as a range of glucose levels exceeding 200 points) was significantly associated with increased rates of reoperation (odds ratio, 4.14, p = 0.025) and trended toward significance with increased rates of dehiscence (p = 0.15). In multivariate regression, only perioperative hyperglycemia and elevated A1c were significantly associated with increased rates of dehiscence.
  
  
  CONCLUSIONS
  In primary closure of surgical wounds in high-risk patients, poor glycemic control is significantly associated with worse outcomes. Every effort should be made to ensure tight control in both the chronic and subacute perioperative periods.
  
  
  METHODS
  Risk, II.
authors.affiliation: Washington, D.C.; Baltimore, Md.; Philadelphia, Pa.; and Boston, Mass. From the Center for Wound Healing, Department of Plastic Surgery, Georgetown University Hospital; Department of Hand Surgery, Union Memorial Hospital; Department of Plastic Surgery, Children's Hospital of Philadelphia; and Department of Surgery, Beth Israel Deaconess Medical Center.
authors.forename: Matthew
authors.initials: M
authors.lastname: Endara
authors.forename: Derek
authors.initials: D
authors.lastname: Masden
authors.forename: Jesse
authors.initials: J
authors.lastname: Goldstein
authors.forename: Stephen
authors.initials: S
authors.lastname: Gondek
authors.forename: John
authors.initials: J
authors.lastname: Steinberg
authors.forename: Christopher
authors.initials: C
authors.lastname: Attinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D002908:Chronic Disease; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012883:Skin Ulcer / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000378:metabolism*; D058106:Wound Closure Techniques
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human