Long-term Glycemic Control and Postoperative Infectious Complications

Hypothesis Good preoperative glycemic control (hemoglobin A1cHbA1c levels Design Retrospective observational study using Veterans Affairs National Surgical Quality Improvement Program data from the Veterans Affairs Connecticut Healthcare System from January 1, 2000, through September 30, 2003. Setting Veterans Affairs Connecticut Healthcare System, a tertiary referral center and major university teaching site. Patients Six hundred forty-seven diabetic patients underwent major noncardiac surgery during the study period; 139 were excluded because the HbA1clevels were more than 180 days prior to surgery; 19 were excluded for other reasons; 490 diabetic patients were analyzed. The study patients were predominantly nonblack men with a median age of 71 years. Main Outcome Measures Primary outcomes were infectious complications, including pneumonia, wound infection, urinary tract infection, or sepsis. Bivariate analysis was used first to determine the association of each independent variable (age, race, diabetic treatment, American Society of Anesthesiologists classification, Activities of Daily Living assessment, elective vs emergent procedure, wound classification, operation length, and HbA1clevels) with outcome. Factors significant atPResults In the multivariable model, age, American Society of Anesthesiologists class, operation length, wound class, and HbA1clevels were significantly associated with postoperative infections. Emergency/urgent cases and dependence in Activities of Daily Living were significant in bivariate analysis but failed to reach statistical significance in the multivariable model. An HbA1clevel of less than 7% was significantly associated with decreased infectious complications with an adjusted odds ratio of 2.13 (95% confidence interval, 1.23-3.70) and aPvalue of .007. Conclusion Good preoperative glycemic control (HbA1clevels <7%) is associated with a decrease in infectious complications across a variety of surgical procedures.