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Glycated Hemoglobin and Risk of Sternal Wound Infection After Isolated Coronary Surgery
Giuseppe Gatti1, Andrea Perrotti, Daniel Reichart
1Division of Cardiac Surgery, Ospedali Riuniti.
Insights
Elevated glycated hemoglobin (HbA1c) levels are linked to a higher risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). Preoperative HbA1c screening can identify high-risk patients for SWI.
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Infectious Diseases
Background:
- Sternal wound infection (SWI) is a significant complication following coronary artery bypass grafting (CABG).
- Glycated hemoglobin (HbA1c) is a potential risk factor for SWI, but its association requires further investigation.
- Understanding glycemic control's impact on postoperative outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the association between preoperative glycated hemoglobin (HbA1c) levels and the incidence of sternal wound infection (SWI) after isolated CABG.
- To determine if HbA1c levels predict SWI risk in the general patient population and in subgroups with and without diabetes.
- To evaluate the clinical utility of HbA1c screening for identifying patients at elevated risk of SWI.
Main Methods:
- Analysis of data from 2,130 patients undergoing isolated CABG within the prospective E-CABG registry.
- Assessment of the correlation between preoperative HbA1c levels and the occurrence of SWI.
- Statistical analysis, including adjusted odds ratios (OR) and 95% confidence intervals (CI), to evaluate risk associations.
Main Results:
- SWI occurred in 5.4% of patients; those with SWI had significantly higher baseline HbA1c levels (54±17 vs. 45±13 mmol/mol, P<0.0001).
- Elevated HbA1c was associated with increased SWI risk across various patient groups, including those without diabetes and with different types of diabetes.
- An HbA1c level >70 mmol/mol was linked to the highest SWI risk (OR, 5.01), while a cutoff of 53 mmol/mol also indicated a significant risk increase (OR, 2.09).
Conclusions:
- Preoperative HbA1c levels are a significant independent predictor of SWI risk after CABG.
- Screening for HbA1c before CABG can identify patients, including those with undiagnosed or poorly controlled diabetes, at high risk for SWI.
- Targeted interventions based on HbA1c levels may help reduce SWI incidence in high-risk surgical patients.
Background:
Glycated hemoglobin (HbA1c) is a suspected risk factor for sternal wound infection (SWI) after CABG.
Methods And Results:
Data on preoperative HbA1c and SWI were available in 2,130 patients undergoing isolated CABG from the prospective E-CABG registry. SWI occurred in 114 (5.4%). Baseline HbA1c was significantly higher in patients with SWI (mean, 54±17 vs. 45±13 mmol/mol, P<0.0001). This difference was also observed in patients without a diagnosis of diabetes (P=0.027), in insulin-dependent diabetic (P=0.023) and non-insulin-dependent diabetic patients (P=0.034). In the overall series, HbA1c >70 mmol/mol (NGSP units, 8.6%) was associated with the highest risk of SWI (20.6% vs. 4.6%; adjusted OR, 5.01; 95% CI: 2.47-10.15). When dichotomized according to the cut-off 53 mmol/mol (NGSP units, 7.0%) as suggested both for diagnosis and optimal glycemic control of diabetes, HbA1c was associated with increased risk of SWI in the overall series (10.6% vs. 3.9%; adjusted OR, 2.09; 95% CI: 1.24-3.52), in diabetic patients (11.7% vs. 5.1%; adjusted OR, 2.69; 95% CI: 1.38-5.25), in patients undergoing elective surgery (9.9% vs. 2.7%; adjusted OR, 2.09; 95% CI: 1.24-3.52) and in patients with bilateral mammary artery grafts (13.7% vs. 4.8%; adjusted OR, 2.35; 95% CI: 1.17-4.69).
Conclusions:
Screening for HbA1c before CABG may identify untreated diabetic patients, as well as diabetic patients with suboptimal glycemic control, at high risk of SWI.
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