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Wound Complications Linked to High Blood Glucose Levels

A new study shows that among patients undergoing surgery for chronic wounds related to diabetes, the extent to which a patient’s blood sugar levels were controlled before surgery affected the risk of wound-related complications. The findings appear in the October issue of Plastic and Reconstructive Surgery.

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

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 (HbA1c), 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, wound infections, and the need for repeat surgery. Blood glucose levels higher than 200 mg/dL were considered to represent hyperglycemia.

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

The risk of wound dehiscence also was higher for patients with high blood glucose levels after surgery and for those with high HbA1c levels. With adjustments for other factors, the risk of wound dehiscence was more than three times higher for patients with hyperglycemia or elevated HbA1c around the time of surgery.

Patients with wide swings in blood glucose levels—a variation of more than 200 points—were about four times more likely to undergo repeat surgery. Otherwise, blood glucose levels and HbA1c were unrelated to the risk of reoperation or wound infections.

In recent years, tight blood glucose control 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. This new study is among 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 wounds is significantly associated with outcomes,” Attinger and colleagues wrote. They note that episodes of high blood glucose can occur around the time of surgery even in patients with good diabetes control previously.

Attinger and his coauthors believe the results help to make the case for tighter glycemic control in patients with diabetes who are undergoing surgery and have a high risk of wound complications. They note that surgeons may need to consult with specialists to manage diabetes control in medically complex patients. However, more research will be needed to confirm whether tighter control of blood glucose levels around the time of surgery actually will reduce the rate of wound-related complications.

— Source: American Society of Plastic Surgeons