High blood sugar levels linked to increased wound complications after surgery

October 1, 2013, Wolters Kluwer Health

A new study released today shows that among patients undergoing surgery for chronic wounds related to diabetes, the risk of wound-related complications is affected by how well the patient's blood sugar levels are controlled before surgery. These findings appear in the October issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The risk of serious is more than three times higher for who have before and after surgery, and in those with poor long-term diabetes control, according to the study by ASPS Member Surgeons Drs. Matthew Endara and Christopher Attinger of the Center for Wound Healing at Georgetown University, Washington, DC. The researchers emphasize the need for "tight control" of before surgery for diabetic patients at high risk of wound complications.

High Blood Glucose Levels Linked to Higher Risk of Wound Complications

The researchers analyzed rates of wound-related complications in 79 patients undergoing surgery for closure of chronic wounds—a common and troublesome complication of diabetes. Blood glucose levels were measured five days before and after surgery. Hemoglobin A1c, a key indicator of long-term diabetes control, was measured an average of two weeks before surgery.

Blood glucose levels and diabetes control were analyzed as risk factors for wound dehiscence (a serious complication in which the surgical incision re-opens), wound infections and need for repeat surgery. Blood glucose levels over 200 were considered to represent elevated blood glucose (hyperglycemia).

The results showed a higher risk of wound complications in patients who had high either before or after surgery. For example, wound dehiscence occurred in about 44 percent of patients who had high glucose levels before surgery, compared to 19 percent of those without preoperative hyperglycemia.

The risk of wound dehiscence was also higher for patients with high blood glucose levels after surgery and for those with high hemoglobin A1c levels (that is, poor long-term diabetes control). With adjustment for other factors, the risk of wound dehiscence was more than three times higher for patients with hyperglycemia or elevated hemoglobin A1c around the time of surgery.

Need for 'Tight Control' of Glucose Levels during Surgery

Patients with wide swings in blood glucose levels—variation of more than 200 points—were about four times more likely to undergo repeat surgery. Otherwise, blood glucose levels and hemoglobin A1c were unrelated to the risk of reoperation or wound infections.

In recent years, tight control of blood glucose levels has been shown to improve a wide array of outcomes in patients with diabetes. For patients with chronic skin ulcers occurring as a complication of diabetes, hyperglycemia has been linked to delayed wound healing and an increased risk of infections. Surprisingly, the new study is one of the first to look at how blood glucose levels affect the risk of complications in patients undergoing surgical treatment for chronic diabetes-related wounds.

"Chronic and perioperative glucose management in high-risk patients undergoing surgical closure of their is significantly associated with outcomes," Dr. Attinger and colleagues write. They note that episodes of high blood glucose can occur around the time of surgery even in many patients with previously good diabetes control.

The results help to make the case for "tighter glycemic control" in diabetic patients undergoing surgery with a high risk of wound complications, Dr. Attinger and co-authors believe. They note that surgeons may need to consult with specialists to manage in these "medically complex patients." However, more research will be needed to confirm whether tighter control of levels around the time of will actually reduce the rate of wound-related complications.

Explore further: Examination of hospital readmissions after plastic surgery aims to cut costs, enhance patient care

Related Stories

Examination of hospital readmissions after plastic surgery aims to cut costs, enhance patient care

August 29, 2013
For patients undergoing plastic and reconstructive surgery procedures, obesity, anemia and postoperative complications—especially surgical and wound complications—are independent risk factors for hospital readmission, ...

Sutures not superior to staples for closure in GI surgery

September 29, 2013
(HealthDay)—Compared with standard procedure using staples, skin closure with subcuticular sutures does not reduce the incidence of wound complications after open gastrointestinal (GI) surgery, according to research published ...

Study shows long-term effects of bariatric surgery in patients with Type 2 diabetes

September 19, 2013
Overweight patients with type 2 diabetes continue to experience the benefits of bariatric surgery up to nine years after the procedure, according to new research from Cleveland Clinic's Bariatric & Metabolic Institute, published ...

Can you predict complications with back surgery? Preoperative factors increase risk

September 3, 2013
For older adults undergoing surgery for spinal stenosis, some simple indicators of poor preoperative health predict a high risk of major medical complications, reports a study in the September 1 issue of Spine.

Study questions the relevance of SCIP benchmarks among CABG patients

November 9, 2012
Cardiothoracic surgeons and endocrinologists from Boston Medical Center (BMC) have found that among patients undergoing coronary artery bypass graft (CABG) surgery, achieving Surgical Care Improvement Project (SCIP) benchmarks ...

Diet shown to be critical factor in improving type 2 diabetes after bariatric surgery

April 2, 2013
Patients with type 2 diabetes who consume a diet identical to the strict regimen followed after bariatric surgery are just as likely to see a reduction in blood glucose levels as those who undergo surgery, researchers at ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.