The Relationship Between Preoperative Glycosylated Hemoglobin Levels and Postoperative Wound Complications in Diabetic Patients Undergoing Hysterectomy

Year 2024, Volume: 6 Issue: 2, 59 - 68, 09.06.2024

Kübra Dilbaz , Ezgi Arabacı , Eylem Ünlübilgin , Fulya Kayıkçıoğlu , Sevgi Koç , Tuğba Kınay , Yaprak Engin Üstün

https://doi.org/10.46969/EZH.1478530

Abstract

Objective: The aim of this study is to investigate whether there is a relationship between glycosylated hemoglobin (HbA1c) and wound complications in diabetic women who have undergone hysterectomy for benign reasons.
Material and Methods: Our retrospective observational study included 153 patients with diabetes mellitus and 154 women without diabetes mellitus who underwent total abdominal (open) hysterectomy for benign reasons at the Gynecology Clinic of Health Sciences University Etlik Zübeyde Hanım Women’s Diseases Training and Research Hospital between January 2016 and November 2022. The HbA1c level and the preoperative fasting blood glucose level were evaluated in 2 groups as patients with and without wound complication. These values were compared with the significance of the results of complications at the wound site.
Results: The study included 307 patients who underwent hysterectomy. All patients underwent open hysterectomy and preoperative 2 g of cefazolin was administered intravenously prophylactically. When the presence of comorbidities (comorbidities other than diabetes mellitus) was analyzed to assess the general health of the patients, a significant difference was found between the groups (p<0.001). 42.2% of patients in the control group and 99.3% of patients in the study group had a diagnosis for a comorbid condition. The HbA1c level and fasting blood glucose level before surgery were not statistically significant in distinguishing wound complications (p=0.588 and p=0.967, respectively). The postoperative 1st day White blood cell (WBC) count was higher in the study group than the control (12611.38±3287.71 vs. 11075.18±3032.68, p 0.013).
Conclusion: In our study, no significant association was found between HbA1c levels and wound complications in patients undergoing hysterectomy for benign reasons. However, it was found that the postoperative 1st day WBC count had predictive value for the wound complication in this population.

Keywords

Glycosylated haemoglobin (HbA1c), blood glucose level, hysterectomy, surgical site infection

Ethical Statement

The present study was approved by the Ethics Committee for Noninterventional Studies of Etlik Zubeyde Hanim Women Health Education Research Hospital on December 26, 2022, with approval number 16.

Supporting Institution

The study did not receive funding.

Histerektomi Operasyonu Geçiren Diyabetik Hastalarda Preoperatif Glikolize Hemoglobin Seviyesi ile Postoperatif Yara Yeri Komplikasyonları Arasındaki İlişki

Abstract

Amaç: Bu çalışmanın amacı, benign nedenlerle histerektomi geçiren diyabetik kadınlarda glikolize hemoglobin (HbA1c) ile yara komplikasyonları arasında bir ilişki olup olmadığını araştırmaktır.
Gereç ve Yöntemler: Retrospektif gözlemsel çalışmamıza Ocak 2016- Kasım 2022 tarihleri arasında Sağlık Bilimleri Üniversitesi Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim Araştırma Hastanesi jinekoloji kliniğinde benign nedenler ile total abdominal (açık) histerektomi yapılan ve diabetes mellitus tanısı olan 153 hasta çalışma grubu, diabetes mellitus tanısı olmayan 154 hasta kontrol grubu olarak dahil edilmiştir. HbA1c düzeyi ve ameliyat öncesi açlık kan şekeri düzeyi, yara komplikasyonu olan ve olmayan hastalar olarak 2 grupta değerlendirildi. Bu değerler yara yerindeki komplikasyonların sonuçlarının anlamlılığı ile karşılaştırıldı.
Bulgular: Çalışmaya histerektomi yapılan 307 hasta dahil edildi. Tüm hastalara açık histerektomi yapıldı ve ameliyat öncesi profilaktik olarak 2 g sefazolin intravenöz olarak uygulandı. Hastaların genel sağlığını değerlendirmek için komorbidite (diabetes mellitus dışındaki komorbiditeler) varlığı analiz edildiğinde, gruplar arasında anlamlı bir fark bulundu (p<0.001). Kontrol grubundaki hastaların %42,2’si ve çalışma grubundaki hastaların %99,3’ü komorbid bir durum için tanı almıştır. Ameliyat öncesi HbA1c düzeyi ve açlık kan şekeri düzeyi yara komplikasyonlarını ayırt etmede istatistiksel olarak anlamlı değildi (sırasıyla p=0.588 ve p=0.967). Ameliyat sonrası 1. gün beyaz kan hücresi (BK) sayısı çalışma grubunda kontrol grubuna göre daha yüksekti (12611.38±3287.71 vs. 11075.18±3032.68, p 0.013).
Sonuç: Çalışmamızda, benign nedenlerle histerektomi yapılan hastalarda HbA1c düzeyleri ile yara komplikasyonları arasında anlamlı bir ilişki bulunmamıştır. Bununla birlikte, postoperatif 1. gün WBC sayısının bu popülasyonda yara komplikasyonu için prediktif değeri olduğu bulunmuştur.

Keywords

Glikolize hemoglobin (HbA1c), kan şekeri düzeyi, histerektomi, cerrahi alan enfeksiyonu

Ethical Statement

Mevcut çalışma Etlik Zübeyde Hanım Kadın Sağlığı Eğitim Araştırma Hastanesi Girişimsel Olmayan Çalışmalar Etik Kurulu tarafından 26 Aralık 2022 tarihinde 16 onay numarası ile onaylandı.

Supporting Institution

Çalışma finansman almadı

References

• Arend RC, Jones BA, Martinez A, Goodfellow P. Endometrial cancer: Molecular markers and management of advanced stage disease. Gynecol Oncol. 2018;150(3):569-80. https://doi.org/10.1016/j.ygyno.2018.05.015
• Duska L, Shahrokni A, Powell M. Treatment of Older Women With Endometrial Cancer: Improving Outcomes With Personalized Care. Am Soc Clin Oncol Educ Book. 2016;35:164-74. https://doi.org/10.1200/EDBK_158668
• Patient CareLink. Healthcare-Acquired Infections (HAIs). 2018. Available at: https://www.patientcarelink.org/improving-patient-care/healthcare-acquired-infections-hais (Accessed on August 5, 2018).
• Lachiewicz MP, Moulton LJ, Jaiyeoba O. Pelvic surgical site infections in gynecologic surgery. Infect Dis Obstet Gynecol. 2015;2015:614950. https://doi.org/10.1155/2015/614950
• Burgess A, Fish M, Goldberg S, Summers K, Cornwell K, Lowe J. Surgical-Site Infection Prevention After Hysterectomy: Use of a Consensus Bundle to Guide Improvement. J Healthc Qual. 2020;42(4):188-94. https://doi.org/10.1097/JHQ.0000000000000224
• Göksever Çelik H, Çelik E, Turan G, Seçkin KD, Gedikbaşı A. Risk factors for surgical site infection after hysterectomy. J Infect Dev Ctries. 2017;11(4):355-60. https://doi.org/10.3855/jidc.9053
• Lake AG, McPencow AM, Dick-Biascoechea MA, Martin DK, Erekson EA. Surgical site infection after hysterectomy. Am J Obstet Gynecol. 2013;209(5):490-9. https://doi.org/10.1016/j.ajog.2013.06.018
• Colling KP, Glover JK, Statz CA, Geller MA, Beilman GJ. Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique. Surg Infect (Larchmt). 2015;16(5):498-503. https://doi.org/10.1089/sur.2014.203
• Mahdi H, Goodrich S, Lockhart D, DeBernardo R, Moslemi-Kebria M. Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data. J Minim Invasive Gynecol. 2014;21(5):901-9. https://doi.org/10.1016/j.jmig.2014.04.003
• Lenz K, Brandt M, Fraund-Cremer S, Cremer J. Coronary artery bypass surgery in diabetic patients - risk factors for sternal wound infections. GMS Interdiscip Plast Reconstr Surg DGPW. 2016;5:Doc18. https://doi.org/10.3205/iprs000097
• Wang TKM, Woodhead A, Ramanathan T, Pemberton J. Relationship Between Diabetic Variables and Outcomes After Coronary Artery Bypass Grafting in Diabetic Patients. Heart Lung Circ. 2017;26(4):371-5. https://doi.org/10.1016/j.hlc.2016.05.117
• Sharif M, Wong CHM, Harky A. Sternal Wound Infections, Risk Factors and Management - How Far Are We? A Literature Review. Heart Lung Circ. 2019;28(6):835-43. https://doi.org/10.1016/j.hlc.2019.01.008
• Wang WH, Hsieh TC, Wu WT, Lee RP, Wang JH, Yeh KT. 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. J Clin Med. 2022;11(19):5552. https://doi.org/10.3390/jcm11195552
• Frisch A, Chandra P, Smiley D, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010;33(8):1783-8. https://doi.org/10.2337/dc10-0304
• Noordzij PG, Boersma E, Schreiner F, et al. Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery. Eur J Endocrinol. 2007;156(1):137-42. https://doi.org/10.1530/eje.1.02321
• Jämsen E, Nevalainen P, Kalliovalkama J, Moilanen T. Preoperative hyperglycemia predicts infected total knee replacement. Eur J Intern Med. 2010;21(3):196-201. https://doi.org/10.1016/j.ejim.2010.02.006
• Carranza-Lira S, Serrano-Estrada FD, López-Muñoz E, Hernández-Jiménez LM, Chavarría-Olarte ME. Glycosylated hemoglobin level in patients with and without surgical site infection after hysterectomy. Cirugia y Cirujanos. 2020;88(3):339-43. https://doi.org/10.24875/CIRUE.M20000137
• Gatti G, Perrotti A, Reichart D, et al. Glycated Hemoglobin and Risk of Sternal Wound Infection After Isolated Coronary Surgery. Circ J. 2016;81(1):36-43. https://doi.org/10.1253/circj.CJ-16-0778
• Shi L, Gu Q, Zhang F, et al. Predictive factors of surgical site infection after hysterectomy for endometrial carcinoma: a retrospective analysis. BMC Surg. 2021;21(1):292. https://doi.org/10.1186/s12893-021-01264-6
• Borchardt RA, Tzizik D. Update on surgical site infections: The new CDC guidelines. JAAPA. 2018;31(4):52-4. https://doi.org/10.1097/01.JAA.0000531052.82007.42
• See I, Soe MM, Epstein L, Edwards JR, Magill SS, Thompson ND. Impact of removing mucosal barrier injury laboratory-confirmed bloodstream infections from central line-associated bloodstream infection rates in the National Healthcare Safety Network, 2014. Am J Infect Control. 2017;45(3):321-3. https://doi.org/10.1016/j.ajic.2016.10.015
• Hodges KR, Davis BR, Swaim LS. Prevention and management of hysterectomy complications. Clin Obstet Gynecol. 2014;57(1):43-57. https://doi.org/10.1097/GRF.0000000000000004
• Lachiewicz MP, Moulton LJ, Jaiyeoba O. Infection Prevention and Evaluation of Fever After Laparoscopic Hysterectomy. JSLS. 2015;19(3):e2015.00065. https://doi.org/10.4293/JSLS.2015.00065
• Matthews KJ, Brock E, Cohen SA, Chelmow D. Hysterectomy in obese patients: special considerations. Clin Obstet Gynecol. 2014;57(1):106-14. https://doi.org/10.1097/GRF.0000000000000005
• Centers for Disease Control (CDC). Surgical site infection (SSI) event. 2014. Available at: http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf (Accessed on March 26, 2014).
• Witter FR, Lawson P, Ferrell J. Decreasing cesarean section surgical site infection: an ongoing comprehensive quality improvement program. Am J Infect Control. 2014;42(4):429-31. https://doi.org/10.1016/j.ajic.2013.12.004
• ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156-8. https://doi.org/10.1097/aog.0b013e3181c33c72
• Blankush JM, Leitman IM, Soleiman A, Tran T. Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery. Ann Med Surg (Lond). 2016;10:77-82. https://doi.org/10.1016/j.amsu.2016.07.025
• Werner BC, Teran VA, Cancienne J, Deal DN. The Association of Perioperative Glycemic Control With Postoperative Surgical Site Infection Following Open Carpal Tunnel Release in Patients With Diabetes. Hand (N Y). 2019;14(3):324-8. https://doi.org/10.1177/1558944717743594
• Molina CS, Stinner DJ, Fras AR, Evans JM. Risk factors of deep infection in operatively treated pilon fractures (AO/OTA: 43). J Orthop. 2015;12(Suppl 1):S7-13. https://doi.org/10.1016/j.jor.2015.01.026
• Cichos KH, Churchill JL, Phillips SG, et al. Metabolic syndrome and hip fracture: Epidemiology and perioperative outcomes. Injury. 2018;49(11):2036-41. https://doi.org/10.1016/j.injury.2018.09.012
• Bhaumik J, Mukhopadhyay A, Ghosh A, Bhattacharya S, Chakraborti B. Postoperative infection rate and clinical outcome after oncosurgery for endometrial carcinoma in a patient population with high prevalence of multidrug-resistant organism colonization and multiple comorbidities. Infect Control Hosp Epidemiol. 2018;39(9):1140-1. https://doi.org/10.1017/ice.2018.172
• Casarin J, Multinu F, Ubl DS, et al. Adoption of Minimally Invasive Surgery and Decrease in Surgical Morbidity for Endometrial Cancer Treatment in the United States. Obstet Gynecol. 2018;131(2):304-11. https://doi.org/10.1097/AOG.0000000000002428