Postoperative hyperglycemia may be key risk factor for surgical site infection

Ata A. Arch Surg. 2010;145:858-864.

Postoperative hyperglycemia may be a significant risk factor for surgical site infection in patients undergoing colorectal or general surgery, according to new findings from a retrospective medical record review.

“Studies have shown that these infections prolong the hospital length of stay after surgery, increase rehospitalization rates and dramatically increase the use of emergency services and health care costs,” according to the researchers.

For the study, researchers assessed whether the presence of perioperative hyperglycemia was associated with an increased risk for surgical site infection in 1,561 patients who underwent general surgery (n=776), vascular surgery (n=559) or colorectal surgery (n=226) at an academic tertiary referral center between 2006 and 2009.

Data were pooled from an institutional quality improvement database. Primary outcome measure was postoperative surgical site infection.

Surgical site infections occurred in 7.42% of the overall cohort. This included 14.11% of patients who underwent colorectal surgery; 10.32% who underwent vascular surgery; and 4.36% who underwent general surgery.

A postoperative serum glucose level of more than 140 mg/dL was the only significant predictor for surgical site infection in patients who underwent colorectal surgery. Compared with only 7.6% of patients with serum glucose levels of 140 mg/dL or less, 20.6% of patients had serum glucose levels of more than 140 mg/dL (95% CI, 1.4-7.2).

Of those who underwent general surgery, age, emergency status, physical status, time in surgery, diabetes or hyperglycemia were all associated with surgical site infection.

Conversely, operative time and presence of diabetes were associated with surgical site infection in patients who underwent vascular surgery, but not postoperative hyperglycemia.

“If hyperglycemia is confirmed in future prospective studies with better postoperative glucose data to be an independent risk factor for postsurgical infection in general surgery patients, this would give surgeons a modifiable variable to reduce the incidence of postoperative infection,” the researchers concluded.

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