Impact Of Short And Long Term Glucose Control In Chronic Limb Threatening Ischemia
Marc Dauer, MD, Paul Yoffe, M.D., Jacob Schriner, M.D., Patricia Friedmann, M.S., Evan Lipsitz, M.D., M.B.A., Jeffery Indes, M.D., Hassan Aldailami, M.D..
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
OBJECTIVE:Peripheral vascular disease affects over 12 million people in the United States. 1-2% of these patients develop chronic limb threatening ischemia (CLTI), the final progression of disease that contributes to tissue loss, gangrene, or rest pain. Diabetes mellitus itself confers over a three-time greater risk of CLTI, with higher amputation rates and lower limb salvage rates when compared to non-diabetics. There is little research on the outcomes of short- and long-term glucose control on CLTI. Our goal is to understand the impact of perioperative glucose level and HgbA1 on CLTI.
METHODS: Retrospective cohort study using a single institutional multi-center database querying all patients admitted for CLTI to a quaternary care hospital from 2014-2019 who underwent a lower extremity operative procedure. Patients were stratified into two groups with perioperative average glucose ranges of ≤ 180 and > 180. A separate analysis grouped patients with preoperative Hgb A1c levels of < 6.5, ≥ 6.5 to 8, ≥ 8. Using univariate and multivariate analyses, outcomes of major amputation, postoperative complication, in-hospital reintervention, and readmission were examined.RESULTS:A total of 292 patients were included in the study. There was no significance between groups for the primary outcome of major amputation or other variables of interest at different preoperative HbA1c or perioperative glucose. (Table 1)CONCLUSIONS:Our study suggests that neither long term nor short term diabetic control has any significant impact on major amputation or significant postoperative complications in CLTI. Previous studies document that patients with diabetes have worse outcomes for limb salvage when compared to non-diabetics, but the cause of this remains unknown. Future directions include stratifying the groups based on WiFi and GLASS anatomic classification systems to identify possible causal factors outside of glucose control alone. Table 1
| Glucose ≤ 180 184/292 (%) | Glucose > 180 108/292 (%) | PValue | Hgb A1c < 6.5 61/292 (%) | Hgb A1c≥6.5-8 91/292 (%) | Hgb A1c≥ 8 140/292 (%) | P Value | |
| Mean Age | 61 | 63 | 61 | 63 | 62 | ||
| Major Amputation | 33 (18) | 18 (17) | 0.78 | 12 (20) | 18 (20) | 21 (15) | 0.56 |
| Perioperative complication | 35(18) | 19 (18) | 0.30 | 11 (18) | 16 (18) | 27 (19) | 0.99 |
| Re-intervention | 30 (16) | 20 (18) | 0.64 | 9 (15) | 14 (15) | 27(19) | 0.65 |
| Re-admission within one year | 94 (51) | 44 (41) | 0.087 | 37 (61) | 44 (48) | 73 (52) | 0.32 |
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