Postoperative hyperglycaemia of diabetic patients undergoing cardiac surgery - a clinical audit

Association Between Levels of Pre-operative Glycosylated Hemoglobin and Post-operative Surgical Site Infections After Elective Surgery in a Low-Income Country

Introduction: Diabetic patients undergoing surgery are more susceptible to hospital-acquired infection, particularly surgical site infection (SSI). Good glycemic control in preoperative patients significantly decreases the risk of SSI. There is a scarcity of data from low-income countries studying the relation between perioperative glycated hemoglobin (HbA1c) levels and postoperative SSI. We aim to establish statistical relation between HbA1c and SSI which will help decrease post-operative infections and morbidity.

Methods: This study was conducted in the surgical unit of Jinnah Sindh Medical University, Karachi, Pakistan, from August 2020 to April 2022. Patients who underwent elective surgical procedures (n= 1024) were included in the study and divided into two groups based on their HbA1c levels. Patients with HbA1c levels higher than 6.5% were classified as group A and those with HbA1c less than 6.5% belonged to group B. For statistical analysis, IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States) was used.

Results: Group A comprised 579 (56.5%) patients. The presence of SSI in participants with HbA1c >6.5% was statistically significant (p-value: 0.011). Genderwise comparison with the presence of SSI was found to be insignificant (p-value: 0.28). Smoking was positively correlated with the absence of SSI. No significance in terms of presence or absence of SSI was found in the comparison of the type of wounds (p-value: 0.25).

Conclusion: There is a positive relationship between raised HbA1c levels and the development of SSI. Our study emphasizes the importance of the use of HbA1c levels as a more accurate predictor of glycemic control in pre-operative patients rather than blood glucose levels. It is imperative that surgeons must check HbA1c levels before selecting patients for elective surgeries, especially in low-income countries where the healthcare burden is already huge.

The economics of glycemic control in the ICU in the United States

PURPOSE OF REVIEW

Currently the USA has an aging population, with increasing deficits and a healthcare system that most would agree is in need of repair. Finding ways to curtail costs is urgently needed. Attention to glycemic control and metabolic care offers a cost-effective method of treatment to reduce complications.

RECENT FINDINGS

Healthcare-related expenses occupy an expanding portion of gross domestic product in the US and are a driver of the deficit. Despite all of this spending, the US receives average marks on outcomes and is not obtaining value in its healthcare. Any movements toward healthcare reform must focus on improving outcomes per healthcare dollar spent, and increasing value. The Affordable Care Act will place greater emphasis on preventing complications and reducing hospital-acquired infections. The original Leuven trial demonstrated that proper implementation of glycemic control can reduce morbidity and mortality. More recent studies have shown that there is a cost-benefit to glycemic control as well, through reduction of hospital stay and prevention of complications. On the basis of these changes, physicians who practice metabolic care and provide glycemic control are well positioned to add value in this era of healthcare reform.

SUMMARY

Glycemic control is inherently valuable in the care of ICU patients as it decreases infectious complications, reduces lengths of stay, and has a positive effect on morbidity and mortality. Further studies should be completed to delineate the exact amount of cost-savings that can be obtained by proper implementation of glycemic control in the ICU.