Virginia Anesthesia Services LLC Increased Infection Risk for Diabetic Surgical Patients - Virginia Anesthesia Services LLC

Increased Infection Risk for Diabetic Surgical Patients

Peripheral neuropathy, a common consequence of suboptimal glycemic control, increases the risk of surgical site infection, improper healing after bone fracture (malunion and nonunion), hospital mortality, and post-surgical amputations in the lower extremities [4],[6]. According to Burgess et al. (2021), endothelial cells are damaged by nonenzymatic glycosylation, high oxidative stress, and dysregulated cellular pathways that significantly disrupt the skin’s normal protective response. This occurrence slows the healing process and increases a diabetic patient’s susceptibility to infection, including surgical infection, and nonunion [2]. Diabetes-related comorbidities, particularly ischemic heart disease and renal impairment, can also exacerbate these issues, increasing the patient’s financial burden due to rising medical care costs. 

Complications of diabetes mellitus can present challenges for surgeons, particularly patients with inadequate glycemic control. Diabetic patients can experience triple the risk of pressure ulcers in surgical and nonsurgical settings, causing infection, diminished quality of life, and prolonged hospitalization. Pressure ulcers can have serious consequences; for example, pressure ulcers after hip surgery were associated with complication rates ranging from 16% to 46% and a mortality rate of 27% [1]. Diabetic foot ulcer (DFU) can pose a significant risk factor in the lower extremities following postoperative procedures. DFU is caused by vascular and neuropathic diseases and can destroy deep tissues resulting in infection, gangrene, necrosis, and skin defects [3]. Approximately 15–34% of diabetic individuals suffer from DFU, with 20% of moderate to severe forms eventually leading to lower limb amputation, significantly impacting an individual’s life [3]. Prevention is the most effective response to combat these issues, with simple inspection being more beneficial than the currently recommended scoring systems. Because most ulcers occur in hospitals, frequently on the day of surgery, prevention efforts must begin upon admission. 

Due to the complicated nature of diabetic wounds and infection risk, post-surgical ulcers continue to be a therapeutic challenge. With the emergence of antibiotic-resistant bacteria, Maggot Debridement Therapy (MDT) has recently been utilized to accelerate diabetic wound healing [3]. MDT, also called “larval therapy,” uses fly larvae to treat DFUs resistant to traditional pharmaceutical treatments in sterile settings. The United States Food and Drug Administration (FDA) has authorized the use of Lucilia sericata larvae for medical purposes following positive trial results [3]. MDT’s primary mechanism reduces the bacterial burden at the infection site by digesting harmful bacteria, destroying biofilms, and producing antibacterial secretions, all of which improve the healing of DFUs and reduce the risk of foot amputation and infection [3]. This new and effective treatment method combined with surgical debridement is a straightforward and cost-effective therapeutic method that, unlike antibiotic therapy, can minimize harm to patients. 

While our understanding of diabetic wound healing mechanisms and infections has dramatically improved in recent years, gaps in our knowledge of clinical wound management remain. Recent studies have reported that personalizing treatment strategies while closely monitoring patient glucose levels can prevent infections and improve surgical outcomes during complex procedures [1]. While standardized guidelines can be challenging to implement across the perioperative period in variable settings, considerable improvements in care with patient benefits and cost savings can be attainable. 

References 

  1. Akiboye, F., & Rayman, G. (2017). Management of Hyperglycemia and Diabetes in Orthopedic Surgery. Current diabetes reports, 17(2), 13. https://doi.org/10.1007/s11892-017-0839-6 
  1. Burgess, J. L., Wyant, W. A., Abdo Abujamra, B., Kirsner, R. S., & Jozic, I. (2021). Diabetic Wound-Healing Science. Medicina (Kaunas, Lithuania), 57(10), 1072. https://doi.org/10.3390/medicina57101072 
  1. Hajimohammadi, K., Parizad, N., Hassanpour, A., & Goli, R. (2021). Saving diabetic foot ulcers from amputation by surgical debridement and maggot therapy: A case report. International journal of surgery case reports, 86, 106334. https://doi.org/10.1016/j.ijscr.2021.106334 
  1. Polachek, W. S., Baker, H. P., Dahm, J. S., Strelzow, J. A., & Hynes, K. K. (2022). Diabetic Kidney Disease Is Associated with Increased Complications Following Operative Management of Ankle Fractures. Foot & ankle orthopaedics, 7(3), 24730114221112106. https://doi.org/10.1177/24730114221112106 
  1. Ramkumar, S., Periasamy, M., Bhardwaj, P., Bharathi, R. R., Mohan, M., & Sabapathy, S. R. (2021). Diabetic Hand Infections: Factors at Presentation Influencing Amputation and Number of Surgical Procedures. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India, 54(3), 289–296. https://doi.org/10.1055/s-0041-1735421 
  1. Wukich D. K. (2015). Diabetes and its negative impact on outcomes in orthopaedic surgery. World journal of orthopedics, 6(3), 331–339. https://doi.org/10.5312/wjo.v6.i3.331