Relationship between perioperative glycemic control and postoperative infections

Hanazaki, Kazuhiro; Maeda, Hiromichi; Okabayashi, Takehiro

doi:10.3748/wjg.15.4122

Cited by 75 publications

(47 citation statements)

References 42 publications

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“…On the other hand, recent meta-analyses [20] and multicenter studies [21] concluded that intensive insulin therapy significantly increased the risk of hypoglycemia and conferred no overall mortality benefit among critically ill patients. The association between perioperative blood glucose range and the incidence of postoperative infection remains unclear in the majority of surgical patients due to lack of evidence [6]. Leukocyte deficiencies and wound healing impairment appear to be reversible and to improve with tight glycemic control [12,13,22].…”

Section: Resultsmentioning

confidence: 99%

“…In patients with severe DM (i.e. HbA1c [ 7.0 % or insulin dependence), perioperative glycemic control is recommended [3][4][5], however, few reports so far clarify the optimal target of perioperative glycemic control to prevent SSI [6]. The objective of this study is to review DM patients underwent spinal instrumentation surgery and to identify the predisposing factors for SSI.…”

Section: Introductionmentioning

confidence: 99%

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Predisposing factors for surgical site infection of spinal instrumentation surgery for diabetes patients

et al. 2013

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Purpose Diabetes mellitus (DM) is known as an important risk factor for surgical site infection (SSI) in spine surgery. It is still unclear however which DM-related parameters have stronger influence on SSI. The purpose of this study is to determine predisposing factors for SSI following spinal instrumentation surgery for patients with DM. Methods 110 DM patients (66 males and 44 females) who underwent spinal instrumentation surgery in one institute were enrolled in this study. For each patient, various preoperative or intraoperative parameters were reviewed from medical records. Patients were divided into two groups (SSI or non-SSI) based on the postoperative course. Each parameter between these two groups was compared. Univariate and multivariate analyses were performed to determine predisposing factor for SSI. Results The SSI group consisted of 11 patients (10 %), and the non-SSI group of 99 patients (90 %). Univariate analysis revealed that preoperative proteinuria (p = 0.01), operation time (p = 0.04) and estimated blood loss (p = 0.02) were significantly higher in the SSI group compared to the non-SSI group. Multivariate logistic regression identified preoperative proteinuria as a statistically significant predictor of SSI (OR 6.28, 95 % CI 1.58-25.0, p = 0.009).Conclusions Proteinuria is a significant predisposing factor for SSI in spinal instrumentation surgery for DM patients. DM patients with proteinuria who are likely to suffer latent nephropathy have a potential risk for SSI. For them less invasive surgery is recommended for spinal instrumentation. In this retrospective study, there was no significant difference of preoperative condition in glycemic control between the two groups.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predisposing factors for surgical site infection of spinal instrumentation surgery for diabetes patients

et al. 2013

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“…In particular, diabetic hyperglycaemia is associated with acidaemia, ketosis and impaired wound healing [2]. Given that reduced preoperative pH level was reported as an important risk factor for inhospital mortality, we found it surprising that the influence of this potential confounding factor was not discussed.…”

Section: Dear Editormentioning

confidence: 94%

Improving outcomes from ischaemic colitis: more questions than answers

Gardiner

McGivney

McGuire

et al. 2014

Int J Colorectal Dis

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Dear Editor:We read with interest the recent paper by Genstorfer et al. [1] that described outcomes and risk factors for in-hospital mortality following surgery for ischaemic colitis. The authors draw attention to a common morbid surgical condition that is frequently fatal. We appreciate that such retrospective cohort studies have many weaknesses as acknowledged by the authors in their discussion. However, we would like to highlight a few significant limitations of this study that require further clarification.First, we were disappointed to note that the presence of known risk factors of adverse surgical outcomes such as diabetes and patient smoking status were not recorded or included in this analysis. In particular, diabetic hyperglycaemia is associated with acidaemia, ketosis and impaired wound healing [2]. Given that reduced preoperative pH level was reported as an important risk factor for inhospital mortality, we found it surprising that the influence of this potential confounding factor was not discussed.Second, the authors report that prior cardiac or aortic surgery was an independent risk factor for in-hospital mortality. However, this conclusion seems somewhat overstated as the results presented suggest, if anything, a weak non-significant association only (OR 2.4; 95 % CI 0.82 to 6.8; P=0.109). In addition, it is unclear why the authors presented postoperative death as "in-patient death" rather than the more conventional 30-day post-operative mortality. This makes comparison with previously published series difficult.Finally, the finding that major post-operative surgical complications were more likely to occur in patients with histologically proven ischaemic changes at the resection margin appears to be at odds with the authors contradictory comment in the discussion that "primary anastomosis can be performed, when blood supply of the residual colon and the formed anastomosis seems to be sufficient in the eyes of an experienced surgeon". Therefore, it would be of interest if the authors could have measured whether the intraoperative assessment of colonic viability correlated well with subsequent histological evaluation.We agree with the authors that larger, prospective, multicentre cohort studies are required to further evaluate predictors of mortality and surgical complications in patients undergoing surgery for ischaemic colitis. It is hoped that identification of clinically relevant factors will not only hasten the accurate diagnosis of ischaemic colitis but also ensure appropriate surgical management, with the aim of reducing the burden of morbidity and mortality associated with this condition. Conflict of interest

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“…Although there has not been a study to demonstrate reduction in peritonitis risk from optimisation of diabetes management, optimal glycaemic control has been shown to reduce the risk of peri-operative infection [29].…”

Section: Preventative Strategiesmentioning

confidence: 99%

Early Onset Peritoneal Dialysis-Related Peritonitis

Ng¹,

Johnson²,

Cho³

2017

J Clin Exp Nephrol

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Peritonitis is a serious and common complication of peritoneal dialysis (PD), representing the commonest cause of technique failure and a not infrequent cause of patient death. Early onset peritonitis, variously defined in the literature as peritonitis occurring within the first 3-20 months of PD, is increasingly being recognised as a discrete and important clinical problem with appreciably heightened risks of technique failure and death. The aim of this review is to provide a comprehensive up to date summary of current evidence surrounding early onset peritonitis and to discuss how to better manage the condition, including suggestions for future research directions.

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Relationship between perioperative glycemic control and postoperative infections

Cited by 75 publications

References 42 publications

Predisposing factors for surgical site infection of spinal instrumentation surgery for diabetes patients

Predisposing factors for surgical site infection of spinal instrumentation surgery for diabetes patients

Improving outcomes from ischaemic colitis: more questions than answers

Early Onset Peritoneal Dialysis-Related Peritonitis

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