Perioperative Hyperglycemia Is a Strong Correlate of Postoperative Infection in Type II Diabetic Patients after Coronary Artery Bypass Grafting.

Abstract

This study was planned to assess the relationship of perioperative glycemic control to the subsequent risk of infectious complications and to compare early clinical outcomes of coronary artery bypass surgery in diabetics with nondiabetics in a single center. A total of 1090 adults who underwent coronary artery surgery in a five year period were included in a retrospective cohort study based on available chart review. Of 1090 patients, 400 had type II diabetes mellitus. Intraoperative and postoperative blood glucose levels in diabetic group were manipulated by means of a continuous insulin infusion. Data of pre- and postoperative blood glucose levels were evaluated with respect to postoperative infection risk for diabetics. Risks of early mortality, cerebrovascular accident, and postoperative infection in diabetic patients were compared with the nondiabetic group. High preoperative mean glucose levels were the main risk factor for the development of postoperative infection (p = 0.012 and p = 0.028 for the mean glucose levels 1 and 2 days before operation, respectively). For diabetic group, of 400 patients 20 (5%) were diagnosed to have postoperative infection (superficial sternal wound in 3 (0.75%), donor site infection in 4 (1%), mediastinitis in 5 (1.25%), urinary tract infection in 6 (1.5%), and lung infection in 2 (0.5%) patients). The diabetic group had significantly higher prevalence of mediastinitis, donor site infection, urinary tract infection and total infection (p values were 0.048, 0.013, 0.009, and 0.044, respectively). Early mortality was higher among diabetics than in nondiabetics (1.73% vs 3%, p = 0.048) but the risk of cerebrovascular accident in diabetics was not greater than in nondiabetics in early period. In patients with diabetes who undergo coronary artery bypass surgery, preoperative hyperglycemia is an independent predictor of short-term infectious complications and total length of stay in hospital.

Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection

“…In addition, postoperative hyperglycemia has been shown to be associated with an increased risk of surgical site infection (SSI) [11,12] . Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces mortality and morbidity in critically ill patients [8,11,12] . These observations led to several short-lived multicenter randomized controlled studies designed to evaluate the benefit of tight glycemic control with intensive insulin therapy [13,14] .…”

Preditores de infecção no pós-operatório de cirurgia de revascularização miocárdica

“…Multivariate analysis showed age, obesity and diabetes mellitus (DM) as independent risk factors for this outcome [7]. In relation to DM, Guven et al [9] demonstrated that hyperglycemia at pre-CABG was the main risk factor for developing post-operative infections; risk can be reduced with improved glycemic control in the perioperative period [10]. Similar results were observed by some authors [11], but not by others [12].…”

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

“…O regime de controle glicêmico por meio ICI foi adotado em seis estudos primários (28,(32)(33)(34)(35)(36) . Uma pesquisa delimitou o controle glicêmico de 100-150mg/dL no perioperatório, usando o regime de ICI em pacientes com e sem diabetes, sendo que os resultados não apresentaram diferença estatisticamente significante na incidência de infecções pós-operatórias entre os grupos (28) .…”

“…de pacientes com diabetes foram identificados com infecção no PO e 2% no grupo de pacientes sem diabetes, os autores concluíram que o controle glicêmico no perioperatório é necessário para redução de complicações infecciosas no PO em pacientes com diabetes submetidos à CRM, sendo a hiperglicemia fator independente para complicações infecciosas e aumento no tempo de internação hospitalar (33) .…”

“…A conclusão da pesquisa apontou que o controle rigoroso da glicose por meio de protocolo de infusão de insulina IV, no pós-operatório, diminui significativamente a incidência de infecção da ferida cirúrgica na amostra com diabetes (36) . recomendaram o controle glicêmico no perioperatório para a prevenção deste tipo de infecção (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)22,(24)(25)(26)(27)(29)(30)(31)(32)(33)(34)(35)(36) .…”