The Association of Diabetes and Glucose Control With Surgical-Site Infections Among Cardiothoracic Surgery Patients

Latham, Robert H.; Lancaster, Ava D.; Covington, Janet F.; Pirolo, John S.; Thomas, Chantal

doi:10.1086/501830

Cited by 497 publications

(320 citation statements)

References 36 publications

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“…In DM patients who underwent major non‐cardiac surgery, a hemoglobin (Hb) A1c level of <7% was significantly associated with decreased infectious complications with an adjusted odds ratio (OR) of 2.13 9. In contrast, Latham et al 8.…”

Section: Introductionmentioning

confidence: 99%

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Takesue

Tsuchida

2017

Annals of Gastroent Surgery

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Perioperative hyperglycemia is a risk factor for surgical site infections (SSI). Although the recommended target blood glucose level (BG) is 140–180 mg/dL for critically ill patients, recent studies conducted in patients undergoing surgery showed a significant benefit of intensive insulin therapy for the management of perioperative hyperglycemia. The aim of the present review is to evaluate the benefits of strict glycemic control for reducing SSI in gastroenterological surgery. We carried out a post‐hoc analysis of the previously published data from research on the risk factors for SSI. The highest BG within 24 hours after surgery was evaluated. A total of 1555 patients were enrolled in the study. In multivariate analysis, a dose–response relationship between the level of hyperglycemia and the odds of SSI was demonstrated when compared with the reference group (≤150 mg/dL) (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.14–2.49 for 150–200 mg/dL; and OR = 2.15, 95% CI 1.40–3.29 for >200 mg/dL). Unexpectedly, hyperglycemia was not a significant risk factor for SSI among diabetes patients. By contrast, non‐diabetes patients with a BG of >150 mg/dL were found to have increased odds of SSI. In conclusion, a target BG of ≤150 mg/dL is recommended in patients without diabetes who undergo gastroenterological surgery. Additional study is required to determine an optimal target BG in diabetes patients. Because of the risk of hypoglycemia, a conventional protocol is indicated for patients admitted to the general ward where frequent glucose measurement is not assured.

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Section: Introductionmentioning

confidence: 99%

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Takesue

Tsuchida

2017

Annals of Gastroent Surgery

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“…However, this risk is doubled in patients with post-operative hyperglycemia, defined as BG (blood glucose) > 200 mg/dL following surgery through POD (post-operative day) 2 [2]. In 2003, the CMS (Centers for Medicare and Medicaid Services) and the CDC (Centers for Disease Control and Prevention) established the SCIP (Surgical Care Improvement Project) to help reduce post-surgical complications.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Glycemic Control with a Pharmacist-Managed Post-Cardiothoracic Surgery Insulin Protocol

Fung¹,

Tom²,

Chiang³

2015

JPP

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Purpose: The purpose of this study is to validate whether a standardized pharmacist-managed protocol improves glycemic control in post-operative patients following cardiothoracic surgery. Methods: The study was conducted via retrospective chart review comparing outcomes from patients treated before and after implementation of a pharmacist-managed insulin protocol. The primary efficacy outcome is defined as the percentage of patients below the target blood glucose level of 200 mg/dL from POD (post-operative day) 1 through POD 2, with secondary outcomes comparing the rates of hypoglycemia, hospital LOS (length of stay), and the incidences of SSI (surgical-site infections) diagnosed through 30 days post-surgery. Eligible participants included all adult patients who had undergone cardiothoracic surgery during the time frame of the study, but excluded any patients requiring intubation or continuous insulin infusion through 12:00 on POD 1. Results: The incidence of post-operative hyperglycemia was similar in the pre-protocol and post-protocol groups with a non-statistically significant trend toward a lower incidence in the post-protocol (19.5% pre-protocol v 12.3% post-protocol, P = 0.05). There were no statistically significant differences between both groups with regard to SSI (2.1% vs 4.7%, P = 0.16), hospital LOS (9.9 days vs 9.6 days, P = 0.46), or hypoglycemia (0.5% vs 2.1%, P = 0.05). Conclusion: The pharmacist-managed insulin protocol resulted in similar rates of post-operative hyperglycemia compared to the pre-protocol group.

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“…[5][6][7][8] Hyperglycemia is also a risk factor for surgical infection in patients undergoing cardiac surgery. 9,10 A landmark prospective randomized controlled clinical trial by van den Berghe et al 11 demonstrated that tight glucose control (target blood glucose level 80-110 mg/dL) with intravenous insulin in critically ill surgical patients led to dramatic reductions in acute renal failure, critical illness polyneuropathy, hospital mortality, and bloodstream infection. Other clinical studies have demonstrated that glycemic control with intravenous insulin improves clinical outcomes and reduces length of stay in patients with diabetes undergoing cardiac surgery.…”

mentioning

confidence: 99%

Evaluation of hospital glycemic control at US Academic Medical Centers

Boord

Greevy

Braithwaite

et al. 2009

Journal of Hospital Medicine

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OBJECTIVE:To evaluate contemporary hospital glycemic management in US academic medical centers.DESIGN: This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics. RESULTS:In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%-63%) and timely admission laboratory glucose measurement (range, 39%-97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose 110 mg/dL.Hyperglycemia was common, 50% of all patients had !1 glucose measurement !180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days. CONCLUSIONS:Despite frequent insulin use, glucose control was suboptimal.

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The Association of Diabetes and Glucose Control With Surgical-Site Infections Among Cardiothoracic Surgery Patients

Cited by 497 publications

References 36 publications

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Evaluation of Glycemic Control with a Pharmacist-Managed Post-Cardiothoracic Surgery Insulin Protocol

Evaluation of hospital glycemic control at US Academic Medical Centers

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