Preoperative hypoglycemia and hyperglycemia are related to postoperative infection rates in implant-based breast reconstruction Tsun yee Law, MD, a Ellie Moeller, BS, a Zachary S. Hubbard, BS, a Samuel Rosas, MD, a Anthony Andreoni, BS, a and Harvey W. Chim, MD b, * a Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida b Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, Florida article info Article history: Received 28 February 2018 Received in revised form 22 May 2018 Accepted 20 June 2018 Available online xxx Keywords: Hypoglycemia Hyperglycemia Breast reconstruction Infection abstract Objectives: Diabetic patients undergoing surgery are known to have a higher risk for infection. However, current literature does not adequately investigate the effects of pre- operative hypoglycemia or hyperglycemia on postoperative infection risk. Methods: A retrospective review of a national private payer database within the PearlDiver Supercomputer application (Warsaw, IN) for patients undergoing breast reconstruction with implant/expander (BR) was conducted. These patients were identified by Current Procedural Terminology (CPT) and International Classification of Disease (ICD-9) ninth revision codes. Glucose ranges were identified by filtering for Logical Observation Identi- fiers Names and Codes ranging from 25 to 219 mg/dL, in 15 mg/mL increments. Patients with preexisting diabetes diagnoses were excluded. These patients were longitudinally tracked for infection at the 90 d and 1-y postoperative period using ICD-9 codes. Results: The search query yielded 13,237 BR procedures with preoperative glycemic levels ranging from 25 to 219 mg/mL. Most procedures (34.6%) were performed on patients with preoperative glycemic levels ranging from 70 to 99 mg/dL. Of the total procedures per- formed (n ¼ 13,237), 19.4% (n ¼ 2564) resulted in infections documented at the 90-d interval, and 24.8% (n ¼ 3285) resulted in infections documented at the 1-y interval. BR patients within the 40-54 mg/dL range had the highest rate of infection (90 d: 30.1%; 1 y: 53.4%). There was a statistically higher incidence of infection among patients with preoperative hypoglycemia (<70 mg/dL). Conclusions: The incidence of infection remains high in preoperatively hyperglycemic pa- tients undergoing breast reconstruction procedures. However, our results show that pre- operatively hypoglycemic patients also have an increased incidence of infection. ª 2018 Elsevier Inc. All rights reserved. Introduction A comprehensive understanding of preoperative risk factors is essential to improving surgical outcomes and reducing infection rates. Numerous studies have demonstrated that diabetic patients undergoing surgery have a higher risk of infection, a difficult wound healing course, and higher complication rates. 1-5 A similar trend is shown in studies of * Corresponding author. Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, 1600 S.W. Archer Rd, Gainesville, FL 32608. Tel.: þ1 352 273 8670; fax: þ1 352 273 8639. E-mail address: harveychim@yahoo.com (H.W. Chim). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  december 2018 (232) 437 e441 0022-4804/$ e see front matter ª 2018 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2018.06.068