Search

Background People with Diabetes Mellitus (DM) are at increased risk of postoperative complications if their HbA1C readings are not well controlled. In the UK, there are clear national guidelines requiring all people with DM to have HbA1C blood testing within 6months before undergoing surgery and that these readings should be below 69 mmol/mol if this is safe to achieve. The aim of this study was to determine whether hospitals in the region were compliant with the guidelines. Methods Data were prospectively collected from seven hospitals across the East of England region from 1st October 2017 to 31st March 2018 (6 months) in all people with DM undergoing elective day case procedures in General and Vascular surgery for benign disease. Results A total of 181 people with DM were included in the study, of whom 77.9% were male patients and the median age was 63 years. The three most commonly performed operations were laparoscopic cholecystectomy (20.9%, n = 38/181), inguinal hernia repair (20.4%, n = 37/181) and umbilical/para-umbilical hernia repair (11.0%, n = 20/181). In keeping with the national guidelines, only 86.7% (n = 157/181) of patients had an HbA1C tested within 6 months prior to their surgery date. Of the patients who had a preoperative HbA1C, 14 (n = 14/157, 8.9%) had an HbA1C ≥ 69 mmol/mol, and 12 (n = 12/14, 85.7%) of these proceeded to surgery without optimisation of their HbA1C. Conclusion A significant proportion of people with diabetes undergoing elective day case procedures in our region do not have HbA1C testing within 6 months of their procedure as recommended by the national guidelines. In patients who do have a high HbA1C, the majority still undergo surgery without adequate control of their DM. Greater awareness amongst healthcare workers and robust pathways are required for this vulnerable group of patients if we are to reduce the risk of developing postoperative complication rates.

Objective To perfect the technique of femtosecond laser–assisted cutting of the lamellar corneal disc in posterior lamellar keratoplasty. Design Experimental study. Methods The femtosecond laser was used to make the posterior corneal lamellar interface and trephine (side) cut in 20 eye bank globes and 9 eye bank corneoscleral buttons. Laser parameters were energy 7.4±0.1 μJ (lamellar cut) and 8.7±0.1 μJ (trephination cut), spot size 2.4 μm, firing rate 15 kHz, and trephination diameter 6.0 to 8.0 mm. The thicknesses of the excised corneal discs were measured with a digital micrometer and compared with values calculated from the laser treatment parameters and the preoperative ultrasound pachymetric readings. The cut surfaces were examined by light microscopy and scanning electron microscopy. In globes, the corneal disc was removed from the eye after laser treatment through a blade incision in the peripheral cornea. In corneoscleral buttons, the posterior disc was peeled off the cornea with forceps after laser treatment on an artificial anterior chamber device. In simulated transplantation, the excised corneal disc was placed into the posterior stromal bed in 7 globes. Results The femtosecond laser was successful in making posterior lamellar and trephination cuts in cornea. The cut surfaces were of very good quality with straight, orthogonal edges, albeit with a mild stucco texture of the lamellar stromal surfaces. In 3 globes, the lamellar surface showed shallow concentric ridges. The measured thickness of the excised discs was 55±61 μm thicker than the preoperatively predicted values. Conclusions These preliminary studies show that the femtosecond laser can make nonmechanical cuts for posterior lamellar keratoplasty with relative ease and reliability, thus facilitating the most technically difficult step in this surgery.