High blood sugar levels increase risk for wound complications following surgery, according to a new study that prompts calls for tighter glucose control among diabetics.
In the study, the risk of serious wound complications was more than three times higher for diabetes patients who have high blood glucose before and after surgery and among those with poor long-term diabetes control.
Drs Mathew Endara and Christopher Attinger of the Center for Wound Healing at Georgetown University, Washington, DC, analyzed rates of wound-related complications among 79 patients undergoing surgery for closure of chronic wounds. Blood glucose levels were measured 5 days before and after surgery, and hemoglobin A1c was measured an average of 2 weeks before surgery. Blood glucose levels over 200 were considered to represent elevated blood glucose. The findings appear in the October issue of Plastic and Reconstructive Surgery.
Wound dehiscence occurred in about 44% of patients who had high glucose levels before surgery, compared to 19% of those without preoperative hyperglycemia, the study showed. In addition, the risk of wound dehiscence was higher among patients with high blood glucose levels after surgery and for those with high hemoglobin A1c levels. After 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.
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.
“Chronic and perioperative glucose management in high-risk patients undergoing surgical closure of their wounds is significantly associated with outcomes,” study authors write. The results help to make the case for “tighter glycemic control” in diabetic patients undergoing surgery with a high risk of wound complications. That said, more research will be needed to confirm whether tighter control of blood glucose levels around the time of surgery will actually reduce the rate of wound-related complications.