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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) 16618895 | Dronge/2005 | 490 adults patients undergoing major non-cardiac general surgery | Retrospective observational study | | Key results | The 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) 19887184 | Acott/2009 | 2960 adult patients undergoing major general surgery | Retrospective observational study | | Key results | The 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) 23644869 | Motta/2013 | 28 adult patients undergoing invasive dental procedures. | Case control study | | Key results | The 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: |
04/02/2014 |
| E-mail |
lohl@livemail.uthscsa.edu |
| Author |
Li Hsing Loh |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Jack Vizuete, DDS |
| Faculty mentor/Co-author e-mail |
VizueteJ@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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