Kalp Cerrahisi Yapılan Hastalarda Derin Sternal Yara İnfeksiyonları ile HbA1c Seviyeleri Arasındaki İlişki

Abstract

Giriş: Kalp cerrahisi yapılan hastalarda, diabetes mellitus (DM)’lu hastalarda olduğu kadar diyabetik olmayan hastalarda da hiperglisemi ile sık karşılaşılır. Kalp cerrahisi sonrasında intraoperatif ve postoperatif hipergliseminin derin sternal yara infeksiyonu (DSYİ) için bağımsız risk faktörü olduğu gösterilmiştir. Ancak, preoperatif kronik glisemik kontrolün DSYİ ile ilişkisi tartışmalıdır. Hemoglobin A1c (HbA1c) geçmiş 2-3 aylık dönemdeki glukoz düzeyi hakkında bilgi verir. Bu çalışmanın amacı koroner baypas cerrahisi yapılan DM’li hastalarda, HbA1c seviyeleri ile DSYİ arasındaki ilişkiyi incelemektir.

Hastalar ve Yöntem: Kliniğimizde kardiyopulmoner baypas altında koroner baypas operasyonu yapılmış olan hastaların kayıtları retrospektif olarak incelendi. DM’si olan ve perioperatif periyodda yeterli glisemik kontrol sağlanmış 180 hasta çalışmaya dahil edildi. DM’si olmayan koroner baypas cerrahisi yapılmış ardışık 200 hasta kontrol grubuna dahil edildi.

Bulgular: Medyan HbA1c değerleri diyabetik hasta grubunda anlamlı olarak daha yüksekti [8.16 (7.2-10.4 vs 5.49 (5-6), p< 0.001]. DSYİ sıklığı bakımdan iki grup arasında istatistiksel olarak anlamlı bir fark saptanmadı [%5 (n= 9) vs %2 (n= 4); p= 0.1]. Yoğun bakımda kalış (p= 0.005) ve hastanede kalış süreleri (p= 0.01) diyabetik hastalarda anlamlı olarak daha uzundu.

Sonuç: Preoperatif dönemdeki yüksek HbA1c seviyeleri koroner baypas sonrası DSYİ ile ilişkili bulunmamıştır. Ayrıca perioperatif periyodda yeterli glisemik kontrol sağlanmış DM’li hastalarda  DSYİ sıklığında artış olmadığı saptanmıştır.

Keywords

• Mediastinit,koroner arter baypas cerrahisi,hemoglobin A1c,diabetes mellitus,derin sternal yara infeksiyonu

Relationship Between Elevated HbA1c and Deep Sternal Wound Infection in Patients Undergoing Cardiac Surgery

Abstract

Introduction: Hyperglycemia is common in patients with and without diabetes mellitus (DM) following cardiac surgery. Intra- and postoperative hyperglycemia has been shown to be an independent risk factor for deep sternal wound infection (DSWI) after cardiac surgery. However, whether the preoperative chronic glycemic control is associated with the risk of DSWI remains controversial. Hemoglobin A1c (HbA1c) provides a measure of glucose control over the prior 2-3 months. The aim of this study was to evaluate the relationship between preoperative HbA1c levels and DSWI in patients with DM undergoing coronary artery bypass grafting (CABG).

Patients and Methods: Records of patients who underwent elective on-pump CABG were retrospectively reviewed. A total of 180 patients with DM were included in the study. Patients were excluded if their blood glucose levels were not adequately controlled in the perioperative period. A total of 200 consecutive patients without DM were taken as controls.

Results: Median HbA1c levels were significantly higher in patients with DM [8.16 (7.2-10.4)] than in controls [5.49 (5-6)] (p< 0.001). There was no significant difference in DSWI incidence between patients with DM and controls [5% (n= 9) vs. 2% (n= 4); P= 0.1]. Hospital (p= 0.01) and intensive care unit stays (p= 0.005) were significantly longer in patients with DM.

Conclusion: We found that DSWI was not associated with preoperative HbA1c levels in patients undergoing CABG. In addition, with adequate glycemic control in the perioperative period, our study demonstrated no significant difference with regard to DSWI between patients with DM and controls.

Keywords

• Mediastinitis,coronary artery bypass grafting,hemoglobin A1c,diabetes mellitus,deep sternal wound infection

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