Postoperative hyperglycaemia of diabetic patients undergoing cardiac surgery – a clinical audit

Lehwaldt, Daniela; O’Connor, Sheila J.M.

doi:10.1111/j.1478-5153.2009.00350.x

Cited by 6 publications

(6 citation statements)

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“…We demonstrate that ideal glycemic control is very di cult to attain in patients with elevated HbA1c. As reported by Lehwaldt et al [12], BSL values appear to peak on the second postoperative day; however, we add to current literature by also demonstrating that the decline after the peak depends upon preoperative HbA1c. We have demonstrated that in patients with HbA1c > 10%, postoperative BSL levels actually peak on the 3 rd postoperative day after which it declines.…”

Section: Discussionsupporting

confidence: 78%

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The Association of Perioperative Glycemic control with Post-operative wound Infection after Coronary Artery Bypass Grafting in Veterans with Diabetes Mellitus

Elgudin

Deo

Rubelowsky

et al. 2021

Preprint

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Introduction: After coronary artery bypass (CABG), diabetes mellitus is associated with increased risk of infection. We model the inter-relationship of pre- and post-operative glycemic control and their composite influence on post-operative wound infection. Methods: 2,899 Veterans that underwent isolated CABG were stratified (Group I: < 8%, Group II: 8 - 10%, Group III: > 10%) according to preoperative HbA1c levels. We obtained the median blood sugar level (BSL) on post-operative days 0 - 4 (POD) and compared trends in BSL readings according to HbA1c groups. We fit a multi-variable random effects mixed model to understand the odds (OR) of developing postoperative mediastinitis. A two-stage joint model was fit to evaluate the adjusted hazard (HR) of pre-operative HbA1c, post-operative BSL and clinical factors on 90-day readmission for infection. Results: In groups I, II, and III had 66%, 25% and 9% patients respectively. In 148,810 post-operative BSL readings, median BSL values peaked at POD 2 (145 mg/dl). In group III, 29% BSL reading was above the recommended limit (< 180 mg/dl). Group III (OR 3.5; p < 0.01) and COPD (OR 2.51; p < 0.01) were associated with higher rates of mediastinitis. Groups II (HR 1.4; p = 0.01) and III (HR 1.5; p = 0.04) were associated with increased risk for 90-day readmission for infection. Post-operative blood sugar levels (p = 0.5) were not associated with increased risk for wound infection at 90 days. Conclusion: Among Veterans undergoing coronary artery bypass, a large proportion had HbA1c levels > 8%. In the post-operative period, 22% of the blood sugar readings are higher than 180 mg/dl. Preoperative HbA1c (rather than postoperative glycemic control) is associated with higher rates of deep sternal wound infection.

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Section: Discussionsupporting

confidence: 78%

“…They report 10% readings of BSL > 200 mg/dl with HbA1c > 6.5 %. Lehwaldt et al [12] audited 150 patients with diabetes mellitus undergoing cardiac surgery in a single center in UK. They report that at least 32%, 24% and 34% readings were above 180 mg/dl (> 10 mmol/lit).…”

Section: Discussionmentioning

confidence: 99%

The Association of Perioperative Glycemic control with Post-operative wound Infection after Coronary Artery Bypass Grafting in Veterans with Diabetes Mellitus

Elgudin

Deo

Rubelowsky

et al. 2021

Preprint

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“…Patients undergoing surgery with hyperglycemia due to type 2 diabetes mellitus (DM) are more susceptible to hospital-acquired infection [3]. In recent years, clinical trials and studies evaluated that blood glucose level control in preoperative patients significantly decreases mortality and morbidity [3].…”

Section: Introductionmentioning

confidence: 99%

Association Between Levels of Pre-operative Glycosylated Hemoglobin and Post-operative Surgical Site Infections After Elective Surgery in a Low-Income Country

Maqsood¹,

Pahawani²,

Shabbir³

et al. 2022

Cureus

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Introduction: Diabetic patients undergoing surgery are more susceptible to hospital-acquired infection, particularly surgical site infection (SSI). Good glycemic control in preoperative patients significantly decreases the risk of SSI. There is a scarcity of data from low-income countries studying the relation between perioperative glycated hemoglobin (HbA1c) levels and postoperative SSI. We aim to establish statistical relation between HbA1c and SSI which will help decrease post-operative infections and morbidity.Methods: This study was conducted in the surgical unit of Jinnah Sindh Medical University, Karachi, Pakistan, from August 2020 to April 2022. Patients who underwent elective surgical procedures (n= 1024) were included in the study and divided into two groups based on their HbA1c levels. Patients with HbA1c levels higher than 6.5% were classified as group A and those with HbA1c less than 6.5% belonged to group B. For statistical analysis, IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States) was used.Results: Group A comprised 579 (56.5%) patients. The presence of SSI in participants with HbA1c >6.5% was statistically significant (p-value: 0.011). Genderwise comparison with the presence of SSI was found to be insignificant (p-value: 0.28). Smoking was positively correlated with the absence of SSI. No significance in terms of presence or absence of SSI was found in the comparison of the type of wounds (p-value: 0.25). Conclusion:There is a positive relationship between raised HbA1c levels and the development of SSI. Our study emphasizes the importance of the use of HbA1c levels as a more accurate predictor of glycemic control in pre-operative patients rather than blood glucose levels. It is imperative that surgeons must check HbA1c levels before selecting patients for elective surgeries, especially in low-income countries where the healthcare burden is already huge.

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“…Já no segundo estudo, os resultados evidenciaram que a administração de insulina glargina e glulisina manteve de forma mais efetiva o controle glicêmico, reduzindo as complicações no PO como ISC, pneumonia e bacteremia (19) . (20) .…”

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“…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) .…”

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

et al. 2013

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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.

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Postoperative hyperglycaemia of diabetic patients undergoing cardiac surgery – a clinical audit

Cited by 6 publications

References 50 publications

The Association of Perioperative Glycemic control with Post-operative wound Infection after Coronary Artery Bypass Grafting in Veterans with Diabetes Mellitus

The Association of Perioperative Glycemic control with Post-operative wound Infection after Coronary Artery Bypass Grafting in Veterans with Diabetes Mellitus

Association Between Levels of Pre-operative Glycosylated Hemoglobin and Post-operative Surgical Site Infections After Elective Surgery in a Low-Income Country

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

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