Hgba1C and Infection in Diabetic Elective Hand Surgery (2012-2018)
Loretta Coady-Fariborzian, MD, Plastic Surgery Section, Malcom Randall VA Medical Center, Gainesville, FL; University of Florida, Gainesville, FL and Christy M Anstead, ARNP-BC, Malcom Randall VA Medical Center, Gainesville, FL
Introduction: Poorly controlled diabetes is a known risk factor for surgical wound infections. Hemoglobin A1C is an indicator of glucose control over a three month period. The plastic surgery service at the Malcom Randall VA Medical Center began screening perioperative hemoglobin A1C (Hgba1c) levels prior to surgery starting August 1, 2015 when a trend in infectious complications was noted in diabetics. We made a cutoff value of <8% for elective hand surgery.
Materials and Methods: The IRB approved a seven year retrospective chart review (#201900402) from January 1, 2012 through December 31, 2018 where we reviewed all our elective hand surgery cases. Diabetic patients were identified from the “problem list” on the history and physical. Data collected included type of surgery, Hgba1C levels within three months prior to surgery, glucose finger sticks the day of surgery, and infectious complications up to 30 days after surgery. A Fisher exact test using a p value of < 0.05 was used to determine if the difference in number of infectious complications after Hgba1C levels were monitored was statistically significant. A logistic regression analysis using a p value of < 0.05 was performed to determine if there was a statistically significant relationship between infectious complications and Hgba1C levels, preoperative finger stick glucose values, or timing of surgery.
Results: Eight hundred forty-eight patients were recorded in the data base. Four hundred thirty five patients with diabetes had surgery before the screening date and 16 (3.68%) had infectious complications. Four hundred thirteen diabetic patients had surgery after the screening began and 11 (2.66%) had infectious complications. Infection complication rates between the two time points were not statistically significant (p=0.44). All major complications (3) requiring a return to the OR involved the original surgery within the flexor sheath and took place before the screening value was enforced. This was not statistically significant (p=0.25). A logistic regression analysis found no correlation with infectious complications based on the three variables of screening date (p=0.99), preoperative finger stick values (p=0.12), or Hgba1c levels (p=0.29).
Conclusion: The data did not support our clinic's strict guidelines for enforcing Hgba1c cutoff levels prior to elective hand surgery; however, we are continuing to screen as part of the general health assessment during the preoperative appointment and will continue to enforce levels <8% when the flexor sheath is likely to be violated as a general precaution.
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