Impact of Postoperative Hyperglycemia on Adverse Outcomes in Microvascular Free Tissue Transfer for Limb Salvage

Postoperative hyperglycemia has been associated with higher rates of complications and prolonged hospitalization. This study aimed to evaluate the effect of postoperative hyperglycemia on outcomes after microvascular free tissue transfer for upper and lower limb salvage.This was a retrospective review of all patients undergoing free tissue transfer for limb salvage at our institution from 2014 to 2024. Rates of surgical site infection (SSI), wound healing complications, flap loss, length of stay, and readmission were compared between patients with postoperative hyperglycemia (≥140 mg/dL within 48 hours of surgery) and normoglycemic patients.One hundred forty-one patients had perioperative glucose values measured and thus were included. Fifty-nine point five seven percent (<i>n</i> = 84) were normoglycemic, while 40.43% (<i>n</i> = 57) had postoperative hyperglycemia. Hyperglycemic patients had higher rates of SSI (33.33% vs. 9.52%, <i>p</i> < 0.01) and wound healing complications (35.09% vs. 21.43%, <i>p</i> = 0.07) compared to normoglycemic patients. The mean length of stay was longer (41.00 vs. 32.83 days, <i>p</i> = 0.04) for hyperglycemic compared to normoglycemic patients. On multivariate analysis, postoperative hyperglycemia was a significant predictor of SSI. Notably, the diagnosis of diabetes mellitus was not a significant predictor of complications (<i>p</i> > 0.05).Postoperative hyperglycemia following free tissue transfer for limb salvage is associated with increased length of stay, and with higher rates of SSI and wound healing complications. Maintenance of perioperative normoglycemia after free tissue transfer is important to optimize patient outcomes.