Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients
Abstract Background Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complicatio...
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-021-01580-1 |
| _version_ | 1818640380468396032 |
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| author | Jef Van den Eynde Abel Van Vlasselaer Annoushka Laenen Delphine Szecel Bart Meuris Tom Verbelen Steven Jacobs Peter Verbrugghe Wouter Oosterlinck |
| author_facet | Jef Van den Eynde Abel Van Vlasselaer Annoushka Laenen Delphine Szecel Bart Meuris Tom Verbelen Steven Jacobs Peter Verbrugghe Wouter Oosterlinck |
| author_sort | Jef Van den Eynde |
| collection | DOAJ |
| description | Abstract Background Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). Methods We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. Results During a median follow-up of 326 days (interquartile range (IQR) 21–1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups. Conclusions Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC. |
| first_indexed | 2024-12-16T23:10:21Z |
| format | Article |
| id | doaj.art-4b5cd44ee15f4e0cb914048295c820de |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-16T23:10:21Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-4b5cd44ee15f4e0cb914048295c820de2022-12-21T22:12:26ZengBMCJournal of Cardiothoracic Surgery1749-80902021-07-011611910.1186/s13019-021-01580-1Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patientsJef Van den Eynde0Abel Van Vlasselaer1Annoushka Laenen2Delphine Szecel3Bart Meuris4Tom Verbelen5Steven Jacobs6Peter Verbrugghe7Wouter Oosterlinck8Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals LeuvenDepartment of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals LeuvenLeuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat)Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals LeuvenDepartment of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals LeuvenDepartment of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals LeuvenDepartment of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals LeuvenDepartment of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals LeuvenDepartment of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals LeuvenAbstract Background Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). Methods We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. Results During a median follow-up of 326 days (interquartile range (IQR) 21–1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups. Conclusions Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC.https://doi.org/10.1186/s13019-021-01580-1Diabetes mellitusGlycemiaHbA1cOPCABSternal wound complicationsSternal wound infections |
| spellingShingle | Jef Van den Eynde Abel Van Vlasselaer Annoushka Laenen Delphine Szecel Bart Meuris Tom Verbelen Steven Jacobs Peter Verbrugghe Wouter Oosterlinck Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients Journal of Cardiothoracic Surgery Diabetes mellitus Glycemia HbA1c OPCAB Sternal wound complications Sternal wound infections |
| title | Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients |
| title_full | Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients |
| title_fullStr | Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients |
| title_full_unstemmed | Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients |
| title_short | Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients |
| title_sort | hemoglobin a1c and preoperative glycemia as a decision tool to help minimise sternal wound complications a retrospective study in opcab patients |
| topic | Diabetes mellitus Glycemia HbA1c OPCAB Sternal wound complications Sternal wound infections |
| url | https://doi.org/10.1186/s13019-021-01580-1 |
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