Postoperative Day 1 Glucose May Be Associated With Wound Complications in Sarcomas Treated With Preoperative Radiation

• Published in: Clinical orthopaedics and related research 2018-03, Vol.476 (3), p.580-586
• Main Authors: Bedi, Meena, King, David M, Mendez, Carlos, Slawski, Barbara, Charlson, John A, Hackbarth, Donald A, Neilson, John C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - blood; Blood Glucose - metabolism; Chemoradiotherapy, Adjuvant - adverse effects; Diabetes Mellitus - blood; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy - adverse effects; Neoplasm Staging; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - physiopathology; Preliminary Data; Radiotherapy, Adjuvant - adverse effects; Retrospective Studies; Risk Factors; Sarcoma - blood; Sarcoma - pathology; Sarcoma - therapy; Soft Tissue Neoplasms - blood; Soft Tissue Neoplasms - pathology; Soft Tissue Neoplasms - therapy; Time Factors; Treatment Outcome; Up-Regulation; Wound Healing; Young Adult
• ISSN: 0009-921X; 1528-1132; 0009-921X
• DOI: 10.1007/s11999.0000000000000056

Uncontrolled blood glucose impacts key phases of the wound healing process. Various factors have been associated with postoperative wound complications in soft tissue sarcomas; however, the association of postoperative early morning blood glucose with wound complications, if any, remains to be determined. Because blood glucose levels may be modified, understanding whether glucose levels are associated with wound complications has potential therapeutic importance. The purposes of this study were (1) to evaluate if postoperative early morning blood glucose is associated with the development of wound complications in soft tissue sarcomas; (2) to determine a blood glucose cutoff that may be associated with an increased risk of wound complications; and (3) to evaluate if patients with diabetes have higher postoperative blood glucose and an associated increased risk of wound complications. From 2000 to 2015, 298 patients with Stage I to III soft tissue sarcomas of the extremity or chest wall were treated with preoperative radiation ± chemotherapy followed by limb-sparing resection. Of those, 191 (64%) patients had demographic, treatment, and postoperative variables and wound outcomes available; these patients' results were retrospectively evaluated. None of the 191 patients were lost to followup. Early morning blood glucose levels on postoperative day (POD) 1 were available in all patients. Wound complications were defined as those resulting in an operative procedure or prolonged wound care for 6 months postresection. Variables that may be associated with wound complications were evaluated using logistic regression for multivariate analysis. Receiver operative curve (ROC) analysis was used to assess the early morning blood glucose level that best was associated postoperative wound complications. After controlling for potentially relevant confounding variables such as patient comorbidities, tumor size, and location, lower extremity soft tissue sarcomas (p = 0.002, odds ratio [OR], 6.4; 95% confidence interval [CI], 1.97-20.84) and elevated POD 1 early morning blood sugars (p < 0.001; OR, 1.1; 95% CI, 1.04-1.11) were associated with increased wound complications postoperatively. ROC analysis revealed that early morning POD 1 blood glucose of > 127 mg/dL was associated with postoperative wound complications with a sensitivity of 89% (area under the curve 0.898, p < 0.001). Median POD 1 early morning blood glucose in patients without diabetes was 118 mg/dL and 153 m