Poor Preoperative Gycemic Control is Associated With Increased Postoperative Infections
Objective To determine whether poor preoperative glycemic control, HgbA1c >7%, is associated with increased postoperative infections.
Design Retrospective database study using Veterans Affairs National Surgical Quality Improvement Program (NSQIP) data fromVA Connecticut from 1/1/00 to 9/30/03.
Setting VA Connecticut is a tertiary referral center and major university teaching site.
Patients 648 diabetic patients underwent major non cardiac surgery during the study period. 139 were excluded because the Hgb A1C levels > 180 days prior to surgery, 19 others for other reasons. 490 diabetic patients were analyzed. The patients were predominately non-black males with a median age of 71 years.
Main Outcome Measures Primary outcomes were infectious complications including pneumonia, wound infection, urinary tract infection or sepsis.
Bivariate analysis was used first to determine the association of each independent variable (age, race, diabetic treatment, ASA classification, ADL’s, emergency vs elective, wound classification, operative length and HgbA1c) with outcome. Factors significant at p<0.05 were used in a multivariable logistic regression model.
Results In the multivariate model age, ASA class, operation length and wound class were significantly associated with postoperative infections. Emergency/urgent cases and dependence in ADL’s were significant in the bivariate analysis, but failed to reach significance in the multivariate model. A HgbA1c > 7% was significantly associated with increased infectious complications with an adjusted odds ratio of 2.133 ( 95% CI 1.229-3.703) and a p value of 0.0071.
Conclusions Poor preoperative glycemic control, Hgb A1c > 7%, is associated with an increase in infectious complications across a variety of surgical procedures.
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