• Matthew Endara, Derek Masden, Jesse Goldstein, Stephen Gondek, John Steinberg, and Christopher Attinger.
• Washington, D.C.; Baltimore, Md.; Philadelphia, Pa.; and Boston, Mass. From the Center for Wound Healing, Department of Plastic Surgery, Georgetown University Hospital; Department of Hand Surgery, Union Memorial Hospital; Department of Plastic Surgery, Children's Hospital of Philadelphia; and Department of Surgery, Beth Israel Deaconess Medical Center.
• Plast. Reconstr. Surg. 2013 Oct 1;132(4):996-1004.

BackgroundThe exact risk that poor glucose control introduces to patients undergoing surgical closure has yet to be fully defined.MethodsThe authors retrospectively analyzed a prospectively collected database of patients seen at their wound care center to evaluate the effects of chronic and perioperative glucose control in high-risk patients undergoing surgical wound closure. Hemoglobin A1c and blood glucose levels for the 5 days before and after surgical closure were recorded and compared with the primary endpoints of dehiscence, infection, and reoperation. Univariate and multivariate analyses were performed.ResultsSeventy-nine patients had perioperative glucose levels and 64 had hemoglobin A1C levels available for analysis. Preoperative and postoperative hyperglycemia (defined as any blood glucose measurement above 200 mg/dl) as well as elevated A1C levels (above 6.5 percent or 48 mmol/ml) were significantly associated with increased rates of dehiscence (odds ratio, 3.2, p = 0.048; odds ratio, 3.46, p = 0.028; and odds ratio, 3.54, p = 0.040, respectively). Variability in preoperative glucose (defined as a range of glucose levels exceeding 200 points) was significantly associated with increased rates of reoperation (odds ratio, 4.14, p = 0.025) and trended toward significance with increased rates of dehiscence (p = 0.15). In multivariate regression, only perioperative hyperglycemia and elevated A1c were significantly associated with increased rates of dehiscence.ConclusionsIn primary closure of surgical wounds in high-risk patients, poor glycemic control is significantly associated with worse outcomes. Every effort should be made to ensure tight control in both the chronic and subacute perioperative periods.Clinical Question/Level Of EvidenceRisk, II.

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