Relationship of Perioperative Hyperglycemia and Postoperative Infections in Patients Who Undergo General and Vascular Surgery

Abstract

The increased risk of POI and length of hospitalization posed by postoperative hyperglycemia is independent of diabetic status and needs further evaluation to assess for possible benefits of postoperative glycemic control in patients who have undergone general surgery.

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

“…There are currently several debates regarding the benefits of strict glucose control in less critically ill patients undergoing elective surgery as opposed to critically ill (medical) patients12, 13, 14, 15, 16, 17, 18 (Table 2). Although the recommended target BG is 140–180 mg/dL for most ICU patients,27 a recent meta‐analysis23 comparing the efficacy between an intensive and a conventional protocol in patients undergoing surgery showed a significant benefit for the intensive protocol in reducing SSI.…”

“…Bivariate analysis revealed that compared with patients with a first postoperative BG ≤110 mg/dL, the likelihood of acquiring an SSI increased progressively for patients with higher BG (OR 3.61 for 111–140 mg/dL; OR 6.26 for 141–180 mg/dL; OR 5.92 for 181–220 mg/dL; and OR 12.13 for >220 mg/dL). In a logistic model, Ramos et al 15. reported that every 40 mg/dL increase from normoglycemia (<110 mg/dL) led to a 30% increased risk of infection.…”

“…The Surgical Care Improvement Project5 (SCIP) developed a quality performance measure to maintain the 6 a.m. controlled blood glucose level (BG) at <200 mg/dL in cardiac surgery (<180 mg/dL in the updated version11). This recommendation has been challenged by recent studies suggesting that an even lower target BG is required to prevent SSI 12, 13, 14, 15, 16, 17, 18. The intensive insulin administration protocol (intensive protocol), however, leads to an increased risk of hypoglycemia, which, in turn, is associated with increased morbidity and mortality 19, 20.…”

“…It seems that very strict glycemic control has modest benefits, with adverse effects often outweighing these advantages in critically ill patients. However, recent studies have indicated differing results for certain patient subgroups, such as surgical patients with acute operative hyperglycemia in the immediate postoperative period 12, 13, 14, 15, 16…”

Preoperative glucose as a screening tool in patients without diabetes

“…[4][5][6][7][8][9] However, the risks of unrecognized hyperglycemia (in patients not known to have diabetes) prior to surgical operations remain unclear. Although Ramos et al have investigated associations between post-operative hyperglycemia and post-operative complications, 10 we were interested in using pre-operative blood glucose as a marker for post-operative complications in patients not known to have diabetes. These patients would not be expected to have HbA1c levels, making blood glucose screening a potentially useful tool to screen for post-operative risks and act as a gateway to connect these patients to short-and long-term monitoring and management of hyperglycemia.…”