Perioperative Tight Glycemic Control for Patients With High Glycated Hemoglobin Undergoing Coronary Artery Bypass Grafting Surgery and Risk of Sternal Wound Infection

Background: High levels of glycated hemoglobin (HbA1c) are a known risk factor for sternal wound infection (SWI). Even with the standard perioperative glycemic control during surgery, SWI is still a common cause of postoperative morbidity in such cases.
Objective: We retrospectively studied the efficacy and applicability of tight glycemic control in preventing postoperative SWI in coronary artery bypass grafting (CABG) patients with raised preoperative HbA1c.
Patients and Methods: This study included 207 type 2 diabetic patients with significantly elevated preoperative HbA1C who underwent isolated CABG at Kasr Al-Ainy and Ain Shams University hospitals during the period from January 2021 to February 2025. Patients were then randomly listed into 2 groups: group A, or the standard group (107 patients), and group B, or the tight control group (100 patients), and we retrospectively analyzed their data concerning postoperative morbidity, particularly surgical site infections, and mortality.
Results: Group B patients experienced significantly more frequent episodes of hypoglycemia (23 vs. 10, P = 0.007) but required lower daily peak insulin infusion doses (8.26 IU vs. 26.4 IU, P < 0.001). Additionally, they exhibited a significantly lower incidence of leg wound infections related to saphenous vein graft harvesting (LWI; 8 vs. 20, P = 0.0246), as well as superficial sternal wound infections (SSWI;7 vs. 17, P = 0.0459) and deep sternal wound infections (DSWI;2 vs. 9, P = 0.0399). Despite the lower incidence of postoperative cerebrovascular stroke (CVS; 1 vs. 3, P = 0.3461) and the need for high doses of vasopressor therapy (7 vs. 12, P = 0.2939) within the same group, the observed difference did not reach a statistically significant level (P value > 0.05). There were no early deaths among our selected population. Conclusion: Despite increasing postoperative hypoglycemic episodes, tight glycemic control has been associated with a significantly lower incidence of surgical site infection without affecting early postoperative mortality in CABG patients with high preoperative HbA1C.