Relationship Between Elevated HbA1c and Deep Sternal Wound Infection in Patients Undergoing Cardiac Surgery

Utkan SEVÜK; Abdulkadir BİLGİÇ; Barış YAYLAK; Nurettin AY; Erkan BAYSAL; Aylin ERKUL; Vahhaç ALP; Ünal BEYAZIT; Süleyman AKKAYA

Journals / Koşuyolu Heart Journal / 2016 / Cilt: 19 - Sayı: 1

Relationship Between Elevated HbA1c and Deep Sternal Wound Infection in Patients Undergoing Cardiac Surgery

Kalp Cerrahisi Yapılan Hastalarda Derin Sternal Yara İnfeksiyonları ile HbA1c Seviyeleri Arasındaki İlişki

Journal: Koşuyolu Heart Journal
Issue: 2016 · Cilt: 19 - Sayı: 1
Pages: 7–11
Publication Date: 2016-04-04
DOI: —

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AI Summary & Key Takeaways

AI Insight

⚡ TL;DR(Too Long; Didn't Read)

In addition, with adequate glycemic control in the perioperative period, our study demonstrated no significant difference with regard to DSWI between patients with DM and controls.

📌 3 Key Takeaways

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Objective & Hypothesis: Introduction: Hyperglycemia is common in patients with and without diabetes mellitus (DM) following cardiac surgery.

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Key Findings & Data:Hemoglobin A1c (HbA1c) provides a measure of glucose control over the prior 2-3 months.

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Conclusion & Impact:In addition, with adequate glycemic control in the perioperative period, our study demonstrated no significant difference with regard to DSWI between patients with DM and controls.

🔬Design:Review & Systematic Survey

📍Scope:Comprehensive Sample

⚙️Variables:Mediastinit · koroner arter baypas cerrahisi · hemoglobin A1c

Abstract

Introduction: Hyperglycemia is common in patients with and without diabetes mellitus (DM) following cardiac surgery. Intra- and postoperative hyperglycemia has been shown to be an independent risk factor for deep sternal wound infection (DSWI) after cardiac surgery. However, whether the preoperative chronic glycemic control is associated with the risk of DSWI remains controversial. Hemoglobin A1c (HbA1c) provides a measure of glucose control over the prior 2-3 months. The aim of this study was to evaluate the relationship between preoperative HbA1c levels and DSWI in patients with DM undergoing coronary artery bypass grafting (CABG). Patients and Methods: Records of patients who underwent elective on-pump CABG were retrospectively reviewed. A total of 180 patients with DM were included in the study. Patients were excluded if their blood glucose levels were not adequately controlled in the perioperative period. A total of 200 consecutive patients without DM were taken as controls. Results: Median HbA1c levels were significantly higher in patients with DM [8.16 (7.2-10.4)] than in controls [5.49 (5-6)] (p< 0.001). There was no significant difference in DSWI incidence between patients with DM and controls [5% (n= 9) vs. 2% (n= 4); P= 0.1]. Hospital (p= 0.01) and intensive care unit stays (p= 0.005) were significantly longer in patients with DM. Conclusion: We found that DSWI was not associated with preoperative HbA1c levels in patients undergoing CABG. In addition, with adequate glycemic control in the perioperative period, our study demonstrated no significant difference with regard to DSWI between patients with DM and controls.

Özet

Giriş: Kalp cerrahisi yapılan hastalarda, diabetes mellitus (DM)’lu hastalarda olduğu kadar diyabetik olmayan hastalarda da hiperglisemi ile sık karşılaşılır. Kalp cerrahisi sonrasında intraoperatif ve postoperatif hipergliseminin derin sternal yara infeksiyonu (DSYİ) için bağımsız risk faktörü olduğu gösterilmiştir. Ancak, preoperatif kronik glisemik kontrolün DSYİ ile ilişkisi tartışmalıdır. Hemoglobin A1c (HbA1c) geçmiş 2-3 aylık dönemdeki glukoz düzeyi hakkında bilgi verir. Bu çalışmanın amacı koroner baypas cerrahisi yapılan DM’li hastalarda, HbA1c seviyeleri ile DSYİ arasındaki ilişkiyi incelemektir. Hastalar ve Yöntem: Kliniğimizde kardiyopulmoner baypas altında koroner baypas operasyonu yapılmış olan hastaların kayıtları retrospektif olarak incelendi. DM’si olan ve perioperatif periyodda yeterli glisemik kontrol sağlanmış 180 hasta çalışmaya dahil edildi. DM’si olmayan koroner baypas cerrahisi yapılmış ardışık 200 hasta kontrol grubuna dahil edildi. Bulgular: Medyan HbA1c değerleri diyabetik hasta grubunda anlamlı olarak daha yüksekti [8.16 (7.2-10.4 vs 5.49 (5-6), p< 0.001]. DSYİ sıklığı bakımdan iki grup arasında istatistiksel olarak anlamlı bir fark saptanmadı [%5 (n= 9) vs %2 (n= 4); p= 0.1]. Yoğun bakımda kalış (p= 0.005) ve hastanede kalış süreleri (p= 0.01) diyabetik hastalarda anlamlı olarak daha uzundu. Sonuç: Preoperatif dönemdeki yüksek HbA1c seviyeleri koroner baypas sonrası DSYİ ile ilişkili bulunmamıştır. Ayrıca perioperatif periyodda yeterli glisemik kontrol sağlanmış DM’li hastalarda DSYİ sıklığında artış olmadığı saptanmıştır.

Keywords

Mediastinit koroner arter baypas cerrahisi hemoglobin A1c diabetes mellitus derin sternal yara infeksiyonu Mediastinitis coronary artery bypass grafting deep sternal wound infection

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Cite This Article

SEVÜK, U., BİLGİÇ, A., YAYLAK, B., AY, N., BAYSAL, E., ERKUL, A., ALP, V., BEYAZIT, Ü., AKKAYA, S. (2016). Relationship Between Elevated HbA1c and Deep Sternal Wound Infection in Patients Undergoing Cardiac Surgery. Koşuyolu Heart Journal, Cilt: 19 - Sayı: 1, 7–11. https://ajindex.com/articles/63947

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References (12)

Salehi Omran A, Karimi A, Ahmadi SH, Davoodi S, Marzban M, Movahedi N, et al. Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): incidence, risk factors and mortality. BMC Infect Dis 2007;7:107-12
Kramer R, Groom R, Weldner D, Gallant P, Heyl B, Knapp R, et al. Glycemic control and reduction of deep sternal wound infection rates. Arch Surg 2008;143:451-6
Lu J, Grayson A, Jha P, Srinivasan A, Fabri B. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 2003;23:943-9
Toumpoulis IK, Anagnostopoulos CE, Derose JJ Jr, Swistel DG. The impact of deep sternal wound infection on longterm survival after coronary artery bypass grafting. Chest 2005;127:464-71
Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis after coronary artery bypass grafting. Risk factors and long-term survival. Ann Thorac Surg 2010;89:1502-9
Milano CA, Kesler K, Archibald N, Sexton DJ, Jones RH. Mediastinitis after coronary bypass graft surgery. Risk factors and long-term survival. Circulation 1995;92:2245-51
Abboud CS, Wey SB, Baltar VT. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg 2004;77:676-83
Aldemir M, Eroğlu D, Adalı F, Emmiler M. Comparison of complications in elderly patients undergoing coronary artery bypass surgery with or without use of the left internal thoracic artery. Koşuyolu Heart Journal 2014;17:118-23
Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol 2002;40:418-23
Szabo Z, Hakanson E, Svedjeholm R. Early post-operative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting. Ann Thorac Surg 2002;74:712-9
Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2005;130:1144.e1-1144.e8
Tas S, Yazıcı D, Dönmez AA, Tunçer EY, Adademir T, Yanartas M, et al. Impact of diabetes and blood glucose control on surgical site infections in cardiac surgery. Kosuyolu Kalp Derg 2013;16:199-204 13. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al. Continuous insulin infusion