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Title It Remains Unclear Whether Elevated HbA1c in Diabetic Patients Undergoing Surgery Increases Post-Surgical Infection Risk
Clinical Question Are patients with uncontrolled diabetes as represented by an elevated HbA1c at a higher risk for infection after invasive dental procedures as compared to patients with well-controlled diabetes?
Clinical Bottom Line It is unclear if elevated HbA1c will increase infection risk in diabetic patients undergoing invasive dental procedures.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16618895Dronge/2005490 adults patients undergoing major non-cardiac general surgeryRetrospective observational study
Key resultsThe authors found that HbA1c levels below 7% were significantly associated with decreased risk of post-operative infections in 490 diabetic patients undergoing major non-cardiac surgical procedures (adj odds ratio = 2.13; 95% CI = 1.23-3.70; P = .007).
#2) 19887184Acott/20092960 adult patients undergoing major general surgeryRetrospective observational study
Key resultsThe authors did not find pre-operative HbA1c levels above 7% to increase post-operative complications statistically in 2960 patients undergoing major surgical procedures (P = .515).
#3) 23644869Motta/201328 adult patients undergoing invasive dental procedures.Case control study
Key resultsThe authors did not find pre-operative HbA1c levels to be indicative of post-operative complications in 28 type 2 diabetic patients undergoing invasive dental procedures (P > .05).
Evidence Search "Postoperative Complications"[Mesh] AND ("Infection"[Mesh] or "Surgical Wound Infection"[Mesh]) AND "Diabetes Mellitus"[Mesh] AND ("Blood Glucose"[Mesh] OR "Hemoglobin A, Glycosylated"[Mesh]) And ("Surgical Procedures, Operative"[Mesh] or “Risk Assessment”[Mesh])
Comments on
The Evidence
PubMed searches on this topic returned no systematic reviews and RCTs and the highest level evidence found were retrospective observational studies of moderate quality and a case control study of moderate quality. The study conducted by Dronge and colleagues was a retrospective cohort study. Limitations of the study were an over-representation of elderly patients (median = 71.3) and male patients (87.8%), and that patients were from a small geographic location. Dronge did not control for smoking history, antibiotic use, and nutritional status, but did control for other major factors. The study by Acott and colleagues was also a retrospective cohort study, and the authors established an exclusion criterion for patient selection. However, the study looked at multiple post-operative complications not limited to infections. The study by Motta was a case control study, and the authors established both inclusion and exclusion criteria for patient selection. A limitation of this study was the limited patient sample size.
Applicability Oral surgeons, periodontists, and dentists planning to perform invasive dental procedures on patients with diabetes are concerned with potential post-operative complications. While it is unclear if elevated HbA1c is a risk factor for post-operative infection risk, it is prudent for practitioners to follow current guidelines for managing patients with diabetes undergoing invasive dental procedures until additional research clarifies the question.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Infection, HbA1c, surgery
ID# 2697
Date of submission: 04/02/2014spacer
E-mail lohl@livemail.uthscsa.edu
Author Li Hsing Loh
Co-author(s) e-mail
Faculty mentor/Co-author Jack Vizuete, DDS
Faculty mentor/Co-author e-mail VizueteJ@uthscsa.edu
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