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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Current evidence suggests that strict glycemic control (normal blood glucose level as the target) is associated with improved outcomes for patients with diabetes; evidence supporting this approach for diabetic patients undergoing a surgical procedure is limited. The authors updated the 2022 guidelines document by adding eight additional studies to the 12 included in the earlier guidelines document.
The new systematic review included data on 2,670 patients who underwent an operative procedure and were randomized to strict glycemic versus conventional therapy. The main outcomes of interest were rates of hypoglycemic events, all-cause mortality, and infectious complications; other outcomes, such as quality of life, cardiovascular events, and length of hospital stay were assessed as well.
The data analysis showed that there was no difference in mortality or infectious complications when the groups were compared. Hypoglycemic events (severe and non-severe) were observed more often in the strict control group. Quality of life, hospital length of stay, and rate of cardiovascular events were similar in the two comparison groups.
The authors concluded that high-certainty evidence supported the conclusion that strict glycemic control for perioperative management of diabetic patients does not reduce mortality risk or rate of infectious complications and is associated with an increased risk for hypoglycemic events.
Small Early Breast Cancers and Negative Axillary Ultrasound Indicate Safe Management without Axillary Surgery
This article reported outcomes from the SOUND randomized trial that compared outcomes in patients with small (2 centimeters diameter or less) early breast cancer (n = 1,463) who had negative axillary ultrasound examination and were randomized to receive sentinel lymph node biopsy (SNLB) or observation. The main outcome of interest was distant disease-free survival at 5 years following initial enrollment in the study.
Among patients who underwent axillary ultrasound, positive examinations were documented in 13.7%. 5-year distant disease-free survival was 97.7% in the SNLB group and 98% in the observation group. Rates of locoregional relapse, distant metastasis, and deaths were less than 3% and were not significantly different in the two groups.
The authors concluded that patients with small early breast cancers and negative axillary ultrasound examination may be safely managed without axillary surgery. The authors and the editorialist noted that SNLB may be indicated for accurate staging of patients who are candidates for systemic therapy. In addition, availability and accuracy of ultrasound examinations may vary in different institutions. Finally, these data should be used by a multidisciplinary team and in shared decision-making with patients to ensure the best outcomes.
Negative Pressure Wound Therapy Should Be Considered for All Surgical Incisions following Primary Closure
The purpose of this systematic review of the literature was to determine the potential benefit of negative pressure wound therapy for reduction of perioperative surgical site infections (SSI), wound dehiscence, non-infectious wound complications, and mortality in patients undergoing all types of surgical procedures.
The authors evaluated data from 57 randomized trials that included 13,744 patients; this evidence was compared with eight previously published systematic reviews. Standardized statistical testing showed that the evaluated data were robust with high certainty of the evidence.
The analysis showed that negative pressure wound therapy compared with standard wound closure techniques significantly reduced the risk for SSI, wound dehiscence, and other incisional complications in all types of surgical procedures. This benefit was observed consistently regardless of risk classification for SSI.
The authors recommended that negative pressure wound therapy be considered for all surgical incisions following primary closure. Expanding the use of negative pressure wound therapy at the local practice level will likely require gathering of data to support a cost/benefit analysis and implementation of focused quality improvement initiatives.
