Poor Glycemic Control Leads to Higher Risk of Wound Complications

New research suggests that poor blood sugar control leads to an increased risk for wound complications in patients undergoing surgery for chronic diabetes-related wounds.

The study authors believe that the key to optimizing outcomes in these complicated patients is ultimately a multidisciplinary approach. “Since our study clearly found a relationship between chronic glycemic control and surgical outcomes, the role of the primary care physician is important not just in the perioperative period, but in the long term for improving surgical outcomes,” said first author Matthew Endara, MD, Administrative Chief Resident at Georgetown University Hospital in Washington DC.

“In addition, if patients are undergoing outpatient surgery, we depend on their PCPs to continually monitor their glucose levels, and we recommend open lines of communication between the specialties regarding glucose and surgical goals.” Endara and his colleagues retrospectively analyzed the rate of wound-related complications in 79 diabetic patients who underwent surgery for closure of chronic wounds at Georgetown’s Center for Wound Healing.

They looked at the effects of blood glucose levels and diabetes control on wound dehiscence (reopening of the surgical incision), wound infections, and need for repeat surgery. They found the risk of serious wound complications is more than three times higher in patients who have high blood glucose levels before and after surgery and in those with poor long-term diabetes control. In addition, patients with wide swings in their blood sugar levels (a variation of more than 200 points) were about four times more likely to undergo repeat surgery.

The authors noted that blood glucose levels can spike around the time of surgery, even in many patients with previously good diabetes control.

Anyone is at risk for episodes of elevated glucose levels when exposed to new stressors—surgery induces the body to respond to the stressor by releasing cortisol, which elevates the glucose levels in the blood. This response can be beneficial in healthy patients because it gives increased energy to the cells responsible for healing by providing fuel for normal cellular respiration. “In the diabetic patient, who is unable to effectively process the increased glucose load, this episode of hyperglycemia can reach pathologic levels and therefore contribute to poor control in the perioperative period,”

Endara said. He and his colleagues hope to perform a prospective trial to further investigate the relationship between glycemic control and surgical outcomes. Specifically, they want to look at the importance of chronic versus perioperative control and what measures should be taken to ensure glucose levels are maintained in normal ranges. The complete study is published in the October issue of Plastic and Reconstructive Surgery.

—Colleen Mullarkey

Reference

Endara M, Masden D, Goldstein J, Gondek S, Steinberg J, Attinger C. The role of chronic and perioperative glucose management in high-risk surgical closures. Plast Reconstr Surg. 2013 Oct;132(4):996-1004.