Preoperative Glycemic Control Reduces Postoperative Infections

Long-term glycemic control in diabetics is linked to a decrease in post-operative infections across a variety of major noncardiac surgical procedures, a new study finds.

The retrospective cohort study examined 490 mainly non-black male patients with a mean age of 71 for a period of six months prior to surgery. Biannual HbA1c levels were selected as the criterion, as suggested by the American Diabetes Association, who recommends this testing frequency for patients with well-controlled glucose.

HbA1c levels, age, operation length, American Society of Anesthesiologists class, and non-clean wound class emerged as significantly related to postoperative infections. The importance of serious comorbidity was also confirmed. The type of diabetic treatment was not significant, as were assessment on the Activities of Daily Living (ADL) scale and urgency of the case, the researchers reported. The researchers concluded that good pre-operative glycemic control six months prior to surgery was associated with a decreased rate of infections. The results were reported in the April 2006 edition of Archives of Surgery.

"Strategies to improve glycemic control prior to elective surgery can be employed to decrease infections and improve overall outcomes for diabetic surgical patients,” said lead author Ronnie Ann Rosenthal, M.D., of Yale University School of Medicine (New Haven, CT, USA), and colleagues.

Why pre-operative glycemic control is linked to reduced post-operative infections can be considered from two perspectives, the investigators reported.. Glucose is a proinflammatory mediator shown to have a wide variety of effects, including stimulating cytokine production and inhibiting endothelial nitric oxide levels. The other possible explanation for the decrease is the overall improvement in the general health and metabolic milieu of the well-controlled diabetic patient.



Related Links:
Yale University School of Medicine