Controle glicêmico no perioperatório: evidências para a prevenção de infecção de sítio cirúrgico

Abstract

Controle glicêmico no perioperatório: evidências para a prevenção de infecção de sítio cirúrgico ABSTRACTThe objective of the present study was to analyze the evidence available in literature regarding blood glucose control to prevent surgical site infection in the perioperative period. The integrative literature review was the chosen review method.The primary studies were searched on the following databases: Medline, CINAHL, EMBASE and LILACS. Of the 26 primary studies included in the review, 12 were conduced with diabetes patients and 14 were performed with patients with and without diabetes; results showed a reduction in surgical site infection rates, mortality, and length of stay, when blood glucose is practiced. Nevertheless, due to the different outlines of the studied included, the investigated sample, type of surgery, blood glucose control parameters and methods, it is concluded that evidence is still insufficient to delimit the best level of target blood glucose and the ideal diet for blood glucose in the perioperative period.Descriptors: Perioperative Nursing; Surgical Wound Infection; Glycemic Index. RESUMENSe objetivó analizar las evidencias disponibles en la literatura sobre control glucémico para prevención de infección del sitio quirúrgico en el perioperatorio. Se adoptó el método de revisión integrativa de literatura. Para localización de los estudios primarios, se seleccionaron las siguientes bases de datos: Medline, CINAHL, EMBASE y LILACS, De los 26 estudios primarios incluidos en la revisión, 12 fueron realizados con muestra de pacientes diabéticos y 14 con pacientes con y sin diabetes; los resultados expresaron reducción en la tasa de infección del sitio quirúrgico, mortalidad y tiempo de internación hospitalaria, cuando se realizó control glucémico. Mientras tanto, en razón de diferencias en el diseño de los estudios incluidos, muestra investigada, tipo de cirugía, parámetros y métodos de control glucémico, se concluye que aún no existen evidencias suficientes como para delimitar el mejor nivel de glucosa-blanco y el régimen ideal para el control glucémico en el perioperatorio.

Total hip arthroplasty complications in patients with or without controlled diabetes mellitus during hospitalization

“…Naturally, alterations vary with the intensity and level of control of the disease. Therefore, it is important to assess the health condition of these patients and the need for surgical intervention, and to analyze the cost–benefit of surgeries such as THA 13, 14…”

Glycemic control strategies and the occurrence of surgical site infection: a systematic review

“…In addition, a recent integrative review found that 23 out of 26 studies emphasized the need for glycemic control, observing an association of hyperglycemia with infections in the postoperative period, highlighting SSIs, increased morbidity, mortality, and costs during hospitalization (5) . A systematic review published in 2009 included only five studies and aimed to verify the relationship between glycemic control and the incidence of surgical site infections, mortality and length of hospital stay.…”

“…They are related to the procedure to be performed, such as type of surgery, its duration, employed techniques, preoperative preparation, and factors related to inoculum of microorganisms, such as their virulence and resistance originating from the environment and the patient's microflora. There are also factors related to patients themselves, as extremes of age, smoking, obesity, malnutrition, use of immunosuppressive drugs, and the presence of chronic diseases such as diabetes mellitus (DM) and hyperglycemia, which motivated this study (3)(4)(5)(6)(7) . In this sense, with significant improvements in quality of life and technological advances, combined with higher survival, there is increased population with chronic diseases (such as diabetes mellitus) that will undergo surgical procedures.…”

“…In 2013, in the state of São Paulo, among the 514 hospitals that performed more than 250 clean surgeries per month such as cardiac, neurological and orthopedic surgery, there was a median of 0.48% cases of SSI (2) . SSIs are the main causes of complications among patients undergoing surgical procedures, increasing hospital length of stay and costs, and also causing physical and emotional damage to patients (3)(4)(5)(6)(7) . SSIs affect the surgical wound and are classified according to the topography.…”

“…In this sense, with significant improvements in quality of life and technological advances, combined with higher survival, there is increased population with chronic diseases (such as diabetes mellitus) that will undergo surgical procedures. Therefore, many chronic diseases need to be stabilized for a successful surgical intervention, i.e., to minimize the occurrence of risks (3,5,(7)(8)(9) . Coupled with DM, hyperglycemia is a frequent problem encountered in patients in critical condition and/ or undergoing surgical procedures.…”