Long-term glycemic control and postoperative infectious complications

Hypothesis: Good preoperative glycemic control (hemoglobin A(1c) [HbA(1c)] levels < 7%) is associated with decreased postoperative infections. 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 HbA(1c) levels 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 HbA(1c) levels) with outcome. Factors significant at P <.05 were used in a multivariable logistic regression model. Results: In the multivariable model, age, American Society of Anesthesiologists class, operation length, wound class, and HbA(1c) levels 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 HbA(1c) level 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 a P value of .007. Conclusion: Good preoperative glycemic control (HbA(1c) levels < 7%) is associated with a decrease in infectious complications across a variety of surgical procedures.