258-OR: Perioperative Glucose Management and Amputation Outcomes

Introduction and Objective: Patients with diabetes have a 15-34% lifetime risk of foot ulcerations and complications from these ulcers are a leading cause of nontraumatic amputations in the United States. Elevated perioperative glucose (>140 mg/dL or A1c ≥8%) is associated with complications in elective surgeries, but limited data exists on its impact on nonelective amputations. This study aims to assess the effect of perioperative glucose levels on outcomes in patients with diabetes undergoing lower extremity amputations after infectious cases. Methods: This two-year retrospective chart review at a large tertiary health system identified 186 patients who underwent lower extremity amputations between January 1, 2021, and December 31, 2022. Glucose levels were measured preoperatively (120-30 minutes before incision), intraoperatively, and postoperatively (30-120 minutes after surgery). Non-eligible patients included non-diabetic related amputations, incomplete follow-up (<6 months), and missing glucose measurements. Outcomes such as healing time, postoperative infection, and hospital readmissions were assessed. Results: 65 patients met eligibility. Postoperative glucose >180 mg/dL significantly delayed healing by ~ 1.6 weeks (p= 0.0255). Healing time was also influenced by amputation level, with transmetatarsal amputations delaying healing by ~ 2.9 weeks (p<0.001). Postoperative infection and peripheral arterial disease (PAD) added ~2.1 weeks (p <0.001) and ~ 1.6 weeks (p = 0.0046) respectively to the average healing time. A1c levels and preoperative glucose levels were non-significant. Conclusion: Postoperative glucose levels >180 mg/dL delayed healing in diabetic patients undergoing amputations. Healing time was also influenced by amputation level, post operative infection, and PAD. These findings emphasize tight perioperative glucose control and lay the groundwork for future research to optimize glucose management in high-risk procedures. Disclosure C. Girgis: None. S. Behme: None. I. Gaynanova: None. B.M. Schmidt: None.