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23rd Annual Pain Medicine Meeting 2024
November 21-23, 2024 | Caesars Palace, Las Vegas, Nevada
6331
IMPACT OF GLYCEMIC CONTROL ON SURGICAL SITE INFECTIONS IN NEUROMODULATION PAIN PROCEDURES: A RETROSPECTIVE ANALYSIS
Poster Presenter
Part of Topic
Safety/QA/QI Projects
Title: Impact of Glycemic Control on Surgical Site Infections in Neuromodulation Pain Procedures: a Retrospective Analysis
Julissa Mireles BS, Saba Javed MD, Xiaowen Sun MS, Jian Wang PhD, Billy K Huh MD, PhD
Background: Surgical site infections are common yet preventable complications following surgical procedures. A substantial body of literature indicates that patients with poor long-term or perioperative glycemic control are more susceptible to postoperative infections. However, optimal HbA1c and glucose targets for neuromodulation pain procedures remain unclear. This quality improvement study aims to examine how diabetes mellitus, HbA1c, perioperative glucose levels, and related variables influence the development of postoperative infections in patients undergoing neuromodulation procedures. Based on our previous experience with postoperative infections in patients with poor perioperative glycemic control, we aim to determine whether diabetic patients with lower hemoglobin A1c levels show reduced postoperative complications and improved patient outcomes.
Methods: This retrospective study, approved by the institutional QIAB with a waiver of consent, analyzed surgical cases from the Department of Pain Medicine between October 2019 to July 2024. Data gathered from the electronic medical record included trials, implants, revisions, and explants related to spinal cord stimulators (SCS), intrathecal drug delivery systems (IDDS), dorsal root ganglion stimulation (DRG-S), intrathecal implants, vertebral augmentation, and peripheral nerve stimulation (PNS). Patient demographics, clinical characteristics, and surgical outcomes were summarized through descriptive statistics. Procedure-related variables (e.g., diabetic status, HbA1C, perioperative glucose, surgery duration) were summarized for each procedure. Continuous variables (e.g., age) were summarized using means, medians, standard deviations, and ranges. Categorical variables (e.g., gender) were summarized using frequencies and proportions. Generalized linear mixed model was used to associate surgical site infections with the demographic and clinical factors.
Results:
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298 surgical cases analyzed
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9 surgical infections occurred (mean HbA1c: 7, mean glucose: 143 mg/dl)
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Postoperative infection rate: 3%
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Significant association between postoperative infections and HbA1c (p-value = 0.0115)
- 1-unit increase in HbA1c → 86.41% increase in odds of postop infection (OR: 1.8641, 95% CI: 1.1497, 3.0225)
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Significant association between postoperative infections and diabetes (p-value = 0.0111)
- Diabetic patients had 6 times higher odds of postop infection (OR: 6.2286, 95% CI: 1.5179, 25.5588)
Conclusion: Surgical site infections were predominantly observed in patients with diabetes mellitus, who commonly had elevated hemoglobin A1c levels and glucose levels. A significant association between postoperative infections and HbA1c was found (p=0.0115), with each unit increase resulting in 86.41% increase in odds of postoperative infection. Similarly, diabetic patients had a significantly higher risk of operative infections (p=0.0111), with odds 6 times greater compared to non-diabetic patients. Diabetes mellitus and elevated HbA1c are significant risk factors for increased infection rates in neuromodulation pain procedures. The overall postoperative infection rate was 3%, similar to the 2.45% rate in patients receiving spinal cord stimulators.2 These findings highlight the need to proactively prevent infections by avoiding high-risk procedures in diabetic patients, thereby enhancing overall patient outcomes. The next step is to identify and propose optimal glycemic control targets for neuromodulation procedures.