The Effect of Diabetes Mellitus on Surgical Site Infections after Colorectal and Noncolorectal General Surgical Operations

Abstract

Patients undergoing colorectal surgery (CRS) are known to be at increased risk of surgical site infection (SSI). We assessed the effect of diabetes and other risk factors on SSI in patients undergoing CRS and patients undergoing general surgery (GS). American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File from 2005 to 2006 was used. χ2 tests, t tests, and logistic regression were used to assess the risk factors. Of the 129,909 study patients 10.1 per cent were patients undergoing CRS. The incidence of SSI in patients undergoing CRS was 3.8 times higher (95% CI, 3.6–4.1) than in patients undergoing GS. The incidence of SSI was higher in diabetics than nondiabetics in patients undergoing CRS (15.4 vs 11.0%, P < 0.001) and patients undergoing GS (5.3 vs 3.1%, P < 0.001). The significant univariate predictors of SSI for patients undergoing GS and patients undergoing CRS were: males, American Society of Anesthesiologists (ASA) class, diabetes emergency surgery, operation time, and greater than 2 units of intraoperative red blood cell transfusion. For patients undergoing GS, increasing age was also significant. After multivariate adjustment, significant predictors of SSI for patients undergoing GS and patients undergoing CRS were: male gender, diabetes, ASA class, emergency surgery, and operation time. For patients undergoing GS, age also remained significant. Among patients undergoing CRS, insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) were 1.32 ( P < 0.05) times more likely than nondiabetics to develop SSI. Among patients undergoing GS, only IDDM (OR, 1.39; P < 0.001) were at increased risk. In this large hospital-based study, patients undergoing CRS were three times more likely to get SSI than patients undergoing GS. Diabetic patients with CRS (IDDM and NIDDM) and patients undergoing GS (IDDM) were at increased risk of SSI compared with nondiabetics. More intense glycemic control may reduce SSI in patients undergoing CRS with diabetes.

Type 2 Diabetes Mellitus and Preoperative HbA1c Level Have no Consequence on Outcomes after Laparoscopic Sleeve Gastrectomy—a Cohort Study

“…DM2 and increased mortality and morbidity in cardiac surgery are connected [4,5]. This association is less clearly documented in other surgical fields [6][7][8][9][10].…”

Surgical Site Infections in Colon Surgery

“…5 Despite the lack of a clear explanation, male sex was independently associated with SSI, as observed in 2 recent publications. 47,48 This could be confounded, for example, by cancer or smoking habits, 2 potential risk factors that were not available in our own database for adjustment and that could be more prevalent in men. Surprisingly, the ASA score and the administration of antibiotic prophylaxis were significantly associated with SSI in univariate analyses but not retained as independent risk factors in the multivariate model, meaning that they could have been confounded by other factors such as the emergency procedure, the surgeons, or the hospitals.…”

The Presence of Diabetes and Higher HbA1c Are Independently Associated With Adverse Outcomes After Surgery

“…Patients with diabetes and chronic hyperglycemia, measured by HbA 1c , may be at particular risk for perioperative morbidity from diabetesrelated complications (5,6). Although diabetes has been associated with increased mortality and morbidity in the setting of cardiac surgery (7,8), this association in the noncardiac surgery setting is variable (9)(10)(11)(12)(13)(14). Inconsistency remains in both the reporting and the definitions of surgical complications and perioperative morbidity among studies, making it difficult to draw conclusions on the association between diabetes and postoperative complications.…”

“…Inconsistency remains in both the reporting and the definitions of surgical complications and perioperative morbidity among studies, making it difficult to draw conclusions on the association between diabetes and postoperative complications. Furthermore, previous studies have used medical records alone to identify diabetes in surgical patients (7,12,14), which may fail to identify the up to 18% who may have diabetes (15).…”