1. 2025;28;539-544Impact of Glycemic Control on Surgical Site Infections in Neuromodulation Pain Procedures: A Retrospective Analysis
   Retrospective Analysis
   Julissa Mireles, BS, Albert Huh, MD, Jian Wang, PhD, Xiaowen Sun, MS, Sara Nalli, BA, Saba Javed, MD, and Billy K. Huh, MD, PhD.

BACKGROUND: Surgical site infections (SSIs) are common and preventable postoperative complications that contribute to increased morbidity, mortality, and health care costs. Diabetes mellitus (DM) is a known risk factor for SSIs across multiple surgical specialties, with poor perioperative glycemic control linked to higher infection rates. While neuromodulation procedures carry infection risks, optimal glycemic targets for these procedures remain unclear. Identifying an optimal glycemic threshold could improve infection rates and patient outcomes within this growing field of neuromodulation.

OBJECTIVES: To examine and compare the effects of Type 1 and Type 2 DM as well as those of hemoglobin A1c (HbA1c), perioperative glucose levels, DM status, and insulin use in association with neuromodulation pain management procedures.

STUDY DESIGN: A single-center retrospective chart review. 

SETTING: This study was conducted at the University of Texas MD Anderson Cancer Center. 

METHODS: This retrospective study examined neuromodulation surgical cases between October 2019 to July 2024 to ascertain the postoperative infection factors. Among the variables studied were demographics, clinical factors, and surgical outcomes. After reviewing the charts of patients who had received qualifying procedures, the researchers investigated any infections that developed in those individuals.

RESULTS: From the 297 surgical cases analyzed, 9 (3%) yielded SSIs. The rate of SSI was significantly higher in patients with Type 1 DM (P = 0.0102), HbA1c levels > 7 (P = 0.0026), perioperative glucose > 200 mg/dl (P = 0.0088), presence of DM (P = 0.0111), and insulin use (P = 0.0244). Data specifically showed a 6.23-fold increase in the odds of developing postoperative infections for DM patients, an 8.72-fold increase in the odds for those with type 1 DM in particular, and an 8.56-fold increase in the odds for patients with HbA1c > 7 over those with an HbA1c < 7. 

LIMITATIONS: Due to the retrospective design of this study, the data eligible for collection were limited to what could be found within the charts available in the electronic medical record. Therefore, the data might have been susceptible to potential confounding and bias.

CONCLUSIONS: Patients with type 1 diabetes, HbA1c > 7, perioperative glucose > 200 mg/dl, presence of DM, and a history of insulin use demonstrated a significantly higher risk of developing postoperative infections after neuromodulation procedures. Identifying the variables that contribute to postoperative infection is important to further reduce surgical complications. Future research goals include establishing glycemic targets for patients who inquire about undergoing neuromodulation procedures to improve those patients’ outcomes.

KEY WORDS: Diabetes, infection, chronic pain, neuromodulation, hemoglobin A1c, surgical site infection, dorsal root ganglion stimulation, peripheral nerve stimulation, spinal cord stimulation, hyperglycemia