Preoperative hemoglobin A1c and perioperative blood glucose in patients with diabetes mellitus undergoing spinal cord stimulation surgery: A literature review of surgical site infection risk

• Published in: Pain practice Vol. 23; no. 1; pp. 83 - 93
• Main Authors: Hagedorn, Jonathan M., Bendel, Markus A., Hoelzer, Bryan C., Aiyer, Rohit, Caraway, David
• Format: Journal Article
• Language: English
• Published: United States 01-01-2023
• Subjects: Blood Glucose; complications; diabetes mellitus; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Glycated Hemoglobin; hemoglobin A1c; Humans; Retrospective Studies; Risk Factors; Spinal Cord Stimulation; surgical site infection; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; diabetes mellitus; spinal cord stimulation; complications; hemoglobin A1c; surgical site infection
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.13145

Aims
The aim of our study was to review the surgical literature regarding the relationship between hemoglobin A1c (HbA1c), diagnosis of diabetes mellitus (DM), and risk of postoperative surgical site infection (SSI).
Methods
A librarian‐assisted literature search was performed with two goals: (1) identify surgical publications related to SSI and HbA1c values, and (2) identify publications reporting infection risk with DM in spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cardiovascular implantable electronic device (CIED) implantation surgeries. Published guidelines on perioperative management of DM are reviewed.
Results
We identified 30 studies reporting SSI and HbA1c values. The literature review indicated that for many surgical procedures, elevated HbA1c is not correlated to rate of SSI. We identified 16 studies reporting infection rates within DM cohorts following SCS, IDDS, and CIED implantation surgeries. The data reviewed did not indicate DM as an independent risk factor for SSI.
Conclusion
Preoperative HbA1c levels in patients with a history of DM is not a singularly sufficient tool to estimate risk of perioperative infection in SCS implantation surgery. Published guidelines on perioperative management of DM do not suggest a specific HbA1c above which surgery should be delayed; intentional perioperative glycemic control is recommended.