The Role of HbA1c as a Positive Perioperative Predictor of Surgical Site and Other Postoperative Infections: An Explorative Analysis in Patients Undergoing Minor to Major Surgery

Andrea Kopp Lugli,Lilian Salm,Walter Paul Weber,Christoph A Fux,Marcel Bundi,Edin Mujagic,Evelin Bucheli Laffer,Walter R Marti,Marco Von Strauss,Michael Coslovsky,Julia Landin,Christoph Kindler

doi:10.1007/s00268-021-06368-x

Andrea Kopp Lugli, Lilian Salm + Show 10 more

Open Access

https://doi.org/10.1007/s00268-021-06368-x

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Abstract

BackgroundPatients with diabetes mellitus type 2 (DM2) inhere impaired peripheral insulin action leading to higher perioperative morbidity and mortality rates, with hospital-acquired infections being one important complication. This post hoc, observational study aimed to analyze the impact of surgical and metabolic stress as defined by the surrogate marker hemoglobin A1c (HbA1c), in relation to self-reported DM2, on perioperative infection rates in a subcohort of the Surgical Site Infection (SSI) Trial population.MethodsAll patients of the SSI study were screened for HbA1c levels measured perioperatively for elective or emergency surgery and classified according to the American Diabetes Association HbA1c cutoff values. SSI and nosocomial infections, self-reported state of DM2 and type of surgery (minor, major) were assessed.ResultsHbA1c levels were measured in 139 of 5175 patients (2.7%) of the complete SSI study group. Seventy patients (50.4%) self-reported DM2, while 69 (49.6%) self-reported to be non-diabetic. HbA1c levels indicating pre-diabetes were found in 48 patients (34.5%) and diabetic state in 64 patients (46%). Forty-five patients of the group self-reporting no diabetes (65.2%) were previously unaware of their metabolic derangement (35 pre-diabetic and 10 diabetic). Eighteen infections were detected. Most infections (17 of 18 events) were found in patients with HbA1c levels indicating pre-/diabetic state. The odds for an infection was 3.9-fold (95% CI 1.4 to 11.3) higher for patients undergoing major compared to minor interventions. The highest percentage of infections (38.5%) was found in the group of patients with an undiagnosed pre-/diabetic state undergoing major surgery.ConclusionsThese results encourage investment in further studies evaluating a more generous and specific use of HbA1c screening in patients without self-reported diabetes undergoing major surgery.Trial registration Clinicaltrials.gov identifier: NCT 01790529

Highlights

Patients undergoing surgery are confronted with a surgeryrelated stress response that induces peripheral insulin resistance
Background Patients with diabetes mellitus type 2 (DM2) inhere impaired peripheral insulin action leading to higher perioperative morbidity and mortality rates, with hospital-acquired infections being one important complication
All patients of the Surgical Site Infection (SSI) study were screened for hemoglobin A1c (HbA1c) levels measured perioperatively for elective or emergency surgery and classified according to the American Diabetes Association HbA1c cutoff values

Summary

Introduction

Patients undergoing surgery are confronted with a surgeryrelated stress response that induces peripheral insulin resistance. Additional stress can be inflicted by a diabetic state, which further amplifies the metabolic derangements The severity of these two stress factors plays a relevant role in outcome, with infection being one of the major complications [1,2,3,4]. Patients with diabetes mellitus type 2 (DM2) inhere impaired peripheral insulin action leading to higher perioperative morbidity and mortality rates, with hospital-acquired infections being one important complication. This post hoc, observational study aimed to analyze the impact of surgical and metabolic stress as defined by the surrogate marker hemoglobin A1c (HbA1c), in relation to self-reported DM2, on perioperative infection rates in a subcohort of the Surgical Site Infection (SSI) Trial population

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Conclusion