Patients with poor glycemic control had worse outcomes after treatment of hand infections

Issue: October 2017

SAN FRANCISCO — Patients with diabetes who had poor inpatient glycemic control experienced worse outcomes after treatment of hand infections compared with patients who did not have diabetes, according to results presented at the American Society for Surgery of the Hand Annual Meeting.

Ketan Sharma, MD, MPH, and colleagues collected patient background, clinical presentation, pathogenic microbiology, surgical triage and infection outcome variables of 322 patients who either had (n=76) or did not have (n=246) diabetes and were treated for hand infections. Repeat drainage and inpatient length of stay were considered clinical outcomes.

“Amongst diabetics, consistent with the existing American Diabetes Association guidelines, poor baseline glycemic control was defined as hemoglobin A1c more than 9% and, importantly, patient glycemic control was defined as average inpatient blood glucose more than 180,” Sharma said in his presentation.

Results showed infections were more likely to occur in the bone, joint and muscle among patients with diabetes. Sharma noted patients with diabetes were more likely to be treated as inpatients after first drainage. Patients with diabetes were also significantly more likely to need repeat drainage, he said. Kaplan-Meyer curve showed a longer inpatient length-of-stay among patients with diabetes.

“When looking at just diabetics alone, poor inpatient glycemic control ... was independently associated with both increased need for repeat drainage and prolonged length of stay,” Sharma said.

He added a significantly reduced need for repeat drainage among patients with diabetes who had good inpatient glycemic control. – by Casey Tingle

Reference:

Sharma K, et al. Paper #63. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 7-9, 2017; San Francisco.

Disclosure: Sharma reports that he has no relevant financial disclosures.