Immediate Preoperative Blood Glucose and Hemoglobin A1c Levels are Not Predictive of Post-operative Infections in Diabetic Men Undergoing Penile Prosthesis Placement
Martin S. Gross, MD1, Maxwell M. Towe, MD2, Lael Reinstatler, MD MPH3, Mohamad M. Osman, MD2, Linda M. Huynh, MD2, Farouk M. El-Khatib, MD2, Gregory Broderick, MD4, Arthur L. Burnett, MD5, Amy I. Guise, MD6, Georgios Hatzichristodoulou, MD7, Jonathan Clavell-Hernandez, MD8, Gerard D. Henry, MD9, Tung-Chin Hsieh, MD10, Lawrence C. Jenkins, MD11, Aaron C. Lentz, MD12, Ricardo M. Munarriz, MD13, Daniar Osmonov, MD14, Sung Hun Park, MD15, Jay Simhan, MD16, Run Wang, MD8, Faisal A. Yafi, MD2
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Keene, NH, 2University of California Irvine, Orange, CA, 3Dartmouth-Hitchcock Medical Center, Lebanon, NH, 4Mayo Clinic-Jacksonville, Jacksonville, FL, 5Johns Hopkins University, Baltimore, MD, 6Medical College of Wisconsin, Milwaukee, WI, 7Julius-Maximilians-University of Würzburg, Würzburg, Germany, 8University of Texas Medical School at Houston, Houston, TX, 9Ark-La-Tex Urology, Shreveport, LA, 10University of California San Diego, San Diego, CA, 11Ohio State University, Columbus, OH, 12Duke University, Raleigh, NC, 13Boston University, Boston, MA, 14University Medical Center Schleswig-Holstein, Kiel, Germany, 15Sewum Urology Center of Excellence, Seoul, Korea, Republic of, 16Einstein Healthcare Network, Philadelphia, PA
BACKGROUND: Recent reports have suggested that pre-operative diabetic control may be predictive of infection rates following penile prosthesis (PP) implantation. In this study, we sought to investigate whether immediate pre-operative serum blood glucose (PBG) levels were associated with PP infection rates in diabetic patients.
METHODS: We conducted a retrospective review of 716 diabetic patients undergoing primary PP (inflatable and malleable) implantation from April 2003 to May 2018 across 15 institutions. PBG levels (within 6 hours of surgery) and Hemoglobin A1c (HbA1c) levels were recorded for each patient, along with clinical and demographic variables. Patients had a median follow up time of 7 months (range 0-157). Measured outcomes were rates of post-operative infection, revision and explantation. The impact of pre-operative glucose and HbA1c on post-operative infection rates was assessed using ANOVA and univariate analyses. The effects of age, diabetes type, diabetes related complications, body mass index, Charlson Comorbidity Index (CCI), history of immunosuppression, previous radical prostatectomy, and PP type were adjusted for, using logistic regression models.
RESULTS: Median age was 61 years (range 34-86). Median and mean pre-operative glucose levels were 134 mg/dL (range 54-344) and 143.3 mg/dL ± 45.9, respectively, and median and mean pre-operative HbA1c levels were 7.2 % (range 4.8-15.2) and 7.5% ± 1.5, respectively. Most PP were inflatable (98.6%). Devices used were AMS 700 (43.2%), AMS Ambicor (0.1%), Coloplast Titan (55.3%), and Coloplast Genesis (1.3%). Surgical approach used was penoscrotal in 74.4%, subcoronal in 23.8%, and infrapubic in 1.8%. Post-operative infection, revision, and explantation rates were 3.8%, 5.9%, and 4.5%, respectively. There was no association between PBG levels and post-operative infection rates: continuous, p=0.413; cut-off >165 mg/dL, 75th percentile, p=0.500; cut-off >201 mg/dL, 90th percentile, p=0.393. Additionally, there was no association between pre-operative HbA1c levels and post-operative infection rates: continuous, p=0.430; cut-off >6.5%, p=0.611; cut-off> 8%, p=0.241. Similarly, there were no associations between explantation and revision rates with PBG levels (p=0.567 and 0.517, respectively), nor with HbA1c levels (p=0.219 and 0.160, respectively). On multivariate analysis, a higher CCI was a significant predictor of higher infection rates (p=0.040).
CONCLUSIONS: In this large multi-institutional cohort of diabetic men undergoing PP implantation, neither PBG nor HbA1c were predictive of device infection. A higher CCI in diabetic patients predicts PP infection.
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