Correlation between the Control of Blood Glucose Level and HbA1C and the Incidence of Surgical Site Infection after Emergent Surgery for the Lower Limb Fracture among Type II DM Patients Aged More Than 50 Years Old

This is the first study focusing on perioperative blood glycemic monitoring for the incidence of surgical site infection (SSI) among patients with type II DM (T2DM) during the 1-year follow-up after emergent orthopedic surgery. We retrospectively collected the data of 604 patients who had received surgery for unilateral lower limb traumatic fracture from January 2011 to January 2021, including 215 men and 389 women with a mean age of 71.21 and a mean BMI of 25.26. In total, 84 (13.9%) of them developed SSI during the 1-year follow-up. Higher preoperative and postoperative -3-month hemoglobin A1c (HbA1c) and AC blood glucose and the presence of rheumatoid arthritis were all associated with increased rates of SSI. The thresholds for predicting SSI were the following: (1) preoperative HbA1c > 7.850% (area under curve [AUC] = 0.793); (2) postoperative HbA1c > 6.650% (AUC = 0.648); (3) preoperative AC blood glucose > 130.50 mg/dL (AUC = 0.773); and (4) postoperative AC blood glucose > 148.5 mg/dL (AUC = 0.709) by receiver-operating characteristic curve method. These findings may provide a useful control guideline for patients with T2DM older than 50 years old and who received surgery for a lower limb fracture in the prevention of postoperative SSI.

Automated summary

This study investigated the association between blood glycemic monitoring and the incidence of surgical site infection (SSI) among patients with type II diabetes mellitus (T2DM) after emergent orthopedic surgery during a 1-year follow-up period. The results showed that higher preoperative and postoperative -3-month hemoglobin A1c (HbA1c) and AC blood glucose levels, as well as the presence of rheumatoid arthritis, were all associated with increased rates of SSI. The thresholds for predicting SSI were identified as preoperative HbA1c > 7.850%, postoperative HbA1c > 6.650%, preoperative AC blood glucose > 130.50 mg/dL, and postoperative AC blood glucose > 148.5 mg/dL. These findings provide useful guidelines for preventing postoperative SSI in patients with T2DM aged over 50 who underwent surgery for lower limb fracture.