Keywords : DIABETES MELLITUS
CORRELATION BETWEEN HEMOGLOBIN A1C IN DIABETIC PATIENTS WITH RATE OF INFECTION AND WOUND COMPLICATIONS FOLLOWING DECOMPRESSIVE SPINE SURGERY
Basrah Journal of Surgery,
Volume 25, Issue 2, Pages 89-94
Diabetes mellitus (DM) is known as an important risk factor for surgical site infection(SSI) in spine surgery. A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infection. Such infection increases morbidity, length of stay, and overall cost. The present study was designed to assess the correlation between pre-operative hemoglobin A1c (HbA1c) and the incidence of post-operative infection in surgical patients undergoing decomperssive spine operations.
Forty diabetic patients who underwent decompressive spine surgery at different levels of spine were included in this retrospective study. These include 23 females and 17 males with mean age of 57.5 years. The patients data were collected from hospitals and private clinics archives including value of preoperative hemoglobin A1c, random blood sugar, postoperative C-reactive protein (CRP) and white blood cells count (WBC) as a diagnostic laboratory tests for identification of postoperative infection in follow-up periods.
The overall rate of infection in our study was 12.5%, which was categorized into 2 groups (Uncontrolled diabetes hemoglobin A1c >7 and controlled hemoglobin A1C ≤7), so the rate of infection was 19.2% among patients with uncontrolled diabetes compared with 0% among patients with controlled diabetes (p=0.143). The mean hemoglobin A1c among patients with uncontrolled diabetes who developed infection was 9.72% compared with 7.34% among those with no infection (p <0.001)
In conclusion, diabetic patients whose blood glucose levels were poorly controlled before surgery as indicated by high hemoglobin A1c were at high risk for postoperative wound infection. Preoperative hemoglobin A1c above 7.34% could serve as a threshold value for significant increased risk of postoperative surgical site infection.
Key words: Diabetes Mellitus, HbA1C, decompressive spine surgery, infection, complications.
Basrah Journal of Surgery,
Volume 17, Issue 1, Pages 0-0
Rabia A Alkaban* & Methal A AL-Rubaee@
*MB,ChB. @MB,ChB, DGO, CABOG, Department of Obstetric & Gynecology, Medical College,
University of Basrah
This is a case-control comparative study carried out over the period (July 2007-July
2008) to identify the frequent type of D.M., analyze demographic features of diabetic
cases as well as to identify maternal, fetal & neonatal complications of D.M. during
This study included 160 diabetic pregnant women as (cases) compared to 180 nondiabetic
pregnant women as (control) who were admitted to three known hospitals with
obstetrical & Gynecology department during same period of study. Such controls had
approximated age & parity to that of cases.
Type 2 DM was the commonest type among cases who tend to be more advanced in
their age with higher BMI compared to controls. Three major risk factors that predispose
to develop GDM were family history of type 2 or GDM, advanced maternal age & obesity.
Diabetic pregnancy was more likely complicated by abortions, hypertensive disorders,
polyhydramnious and preterm delivery with high C/S rate as well as P.P.H. & birth tract
injury in comparison to controls. Cephalo-pelvic disproportion consequent to
macrosomia was main indication for C/S in diabetic cases in whom not only macrosomic
newborns were more but also stillbirth rate was higher with lower Apgar score & more
admission to NICU.
Diabetic newborns were more likely to be affected by RDS, hypoglycemia & congenital
In conclusion, D.M. is a major medical disorder that exhibit burden on health of both
mother & fetus with high maternal morbidity, prenatal & neonatal morbidity & mortality.