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Techniques in Coloproctology

, Volume 22, Issue 3, pp 201–207 | Cite as

Perioperative hyperglycemia: an unmet need within a surgical site infection bundle

  • M. Gachabayov
  • A. J. Senagore
  • S. K. Abbas
  • S. B. Yelika
  • K. You
  • R. Bergamaschi
Original Article

Abstract

Background

The aim of this study was to determine whether perioperative stress hyperglycemia is correlated with surgical site infection (SSI) rates in non-diabetes mellitus (DM) patients undergoing elective colorectal resections within an SSI bundle.

Methods

American College of Surgeons National Surgical Quality Improvement Program data of patients treated at a single institution in 2006–2012 were supplemented by institutional review board-approved chart review. A multifactorial SSI bundle was implemented in 2009 without changing the preoperative 8-h nil per os, and in the absence of either a carbohydrate loading strategy or hyperglycemic management protocol. Hyperglycemia was defined as blood glucose level > 140 mg/dL. The primary endpoint was SSI defined by the Centers for Disease Control National Nosocomial Infections Surveillance.

Results

Of 690 patients included, 112 (16.2%) had pre-existing DM. Overall SSI rates were significantly higher in DM patients as compared to non-DM patients (28.7 vs. 22.3%, p = 0.042). Postoperative hyperglycemia was more frequently seen in non-DM patients (46 vs. 42.9%). The SSI bundle reduced SSI rates (17 vs. 29.3%, p < 0.001), but the rate of hyperglycemia remained unchanged for DM or non-DM patients (pre-bundle 59%; post-bundle 62%, p = 0.527). Organ/space SSI rates were higher in patients with pre- and postoperative hyperglycemia (12.6%) (p = 0.017). Overall SSI rates were higher in DM patients with hyperglycemia as compared to non-DM patients with hyperglycemia (35.6 vs. 20.8%, p = 0.002). At multivariate analysis DM, chronic steroid use, chemotherapy and SSI bundle were predictive factors for SSI.

Conclusions

This study showed that non-DM patients have a postoperative hyperglycemia rate as high as 46% in spite of the SSI bundle. A positive correlation was found between stress hyperglycemia and organ/space SSI rates regardless of the DM status. These data support the need for a strategy to prevent stress hyperglycemia in non-DM patients undergoing colorectal resections.

Keywords

Colorectal resection Perioperative hyperglycemia Surgical site infection 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional review board approval was obtained prior to initiating the study.

Informed consent

Informed consents are not applicable to this study as it was a retrospective study.

References

  1. 1.
    Keenan JE, Speicher PJ, Thacker JK et al (2014) The preventative surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings. JAMA Surg 149(14):1045–1052CrossRefPubMedGoogle Scholar
  2. 2.
    Tanner J, Khan D, Ball J et al (2009) Post discharge surveillance to identify colorectal surgical site infection rates and costs. J Hosp Infect 72(3):242–250CrossRefGoogle Scholar
  3. 3.
    Thompson KM, Oldenburg WA, Deschamps C et al (2011) Chasing zero: the drive to eliminate surgical site infections. Ann Surg 254(3):430–436 discussion 436–437 CrossRefPubMedGoogle Scholar
  4. 4.
    Mahmoud NN, Turpin RS, Yang G, Saunders WB (2009) Impact of surgical site infections on length of stay and costs in selected colorectal procedures. Surg Infect (Larchmt) 10(6):539–544CrossRefGoogle Scholar
  5. 5.
    The Joint Commission Accountability Measure List (2015). https://www.jointcommission.org/assets/1/18/ACCOUNTABILITYMEASURESList_2014_May2015.pdf. Accessed 22 Mar 2017
  6. 6.
    Dungan KM, Braithwaite SS, Preiser JC (2009) Stress hyperglycemia. Lancet 373(9677):1798–1807CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    May AK, Kauffmann RM, Collier BR (2011) The place for glycemic control in the surgical patient. Surg Infect 12(5):405–418CrossRefGoogle Scholar
  8. 8.
    Kwon S, Thompson R, Delinger P, Yanez D, Farrohki E, Flum D (2013) Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 257(1):8–14CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    McConnell YJ, Johnson PM, Porter GA (2009) Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointest Surg 13(3):508–515CrossRefPubMedGoogle Scholar
  10. 10.
    Ljungqvist O, Søreide E (2003) Preoperative fasting. Br J Surg 90(4):400–406CrossRefPubMedGoogle Scholar
  11. 11.
    Ramos M, Khalpey Z, Lipsitz S et al (2008) Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg 248(4):585–591PubMedGoogle Scholar
  12. 12.
    Hanazaki K, Maeda H, Okabayashi T (2009) Relationship between perioperative glycemic control and postoperative infections. World J Gastroenterol 15(33):4122–4125CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Gianotti L, Biffi R, Sandini M et al (2007) Preoperative oral carbohydrate load versus placebo in major elective abdominal surgery (PROCY): a randomized, placebo-controlled, multicenter, phase III trial. Ann Surg.  https://doi.org/10.1097/SLA.0000000000002325 Google Scholar
  14. 14.
    Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13(10):606–608CrossRefPubMedGoogle Scholar
  15. 15.
    Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147(8):573–577CrossRefGoogle Scholar
  16. 16.
    User Guide for the 2014 ACS NSQIP Participant Use Data File (PUF), American College of Surgeons, Chicago, IL (2014). https://www.facs.org/~/media/files/quality%20programs/nsqip/nsqip_puf_userguide_2014.ashx. Accessed 22 Mar 2017
  17. 17.
    Connolly TM, Foppa C, Kazi E, Denoya PI, Bergamaschi R (2016) Impact of a surgical site infection reduction strategy after colorectal resection. Colorectal Dis 18(9):910–918CrossRefPubMedGoogle Scholar
  18. 18.
    Martin ET, Kaye KS, Knott C et al (2016) Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 37(1):88–99CrossRefPubMedGoogle Scholar
  19. 19.
    Bower WF, Jin L, Underwood MJ et al (2010) Overt diabetes mellitus adversely affects surgical outcomes of noncardiovascular patients. Surgery 147(5):670–675CrossRefPubMedGoogle Scholar
  20. 20.
    Ceriello A, Esposito K, Piconi L et al (2008) Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes 57(5):1349–1354CrossRefPubMedGoogle Scholar
  21. 21.
    Thompson RE, Broussard EK, Flum DR, Wisse BE (2016) Perioperative glycemic control during colorectal surgery. Curr Diab Rep 16(3):32CrossRefPubMedGoogle Scholar
  22. 22.
    Kiran RP, Turina M, Hammel J, Fazio V (2013) The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal surgery: evidence for the need for tight glucose control? Ann Surg 258(4):599–604 discussion 604–605 PubMedGoogle Scholar
  23. 23.
    Vigano J, Cereda E, Caccialanza R et al (2012) Effects of preoperative oral carbohydrate supplementation on postoperative metabolic stress response of patients undergoing elective abdominal surgery. World J Surg 36(8):1738–1743CrossRefPubMedGoogle Scholar
  24. 24.
    Kielhorn BA, Senagore AJ, Asgeirsson T (2017) The benefits of a low dose complex carbohydrate/citrulline electrolyte solution for preoperative carbohydrate loading: focus on glycemic variability. Am J Surg.  https://doi.org/10.1016/j.amjsurg.2017.10.029 Google Scholar
  25. 25.
    Institute for Healthcare Improvement (IHI). What is a bundle? www.ihi.org/resources/Pages/ImprovementStories/WhatIsaBundle.aspx. Accessed 29 Mar 2017
  26. 26.
    Tanner J, Padley W, Assadian O, Leaper D, Kiernan M, Edmiston C (2015) Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8515 patients. Surgery 158(1):66–77CrossRefPubMedGoogle Scholar
  27. 27.
    Jackson RS, Amdur RL, White JC, Macsata RA (2012) Hyperglycemia is associated with increased risk of morbidity and mortality after colectomy for cancer. J Am Coll Surg 214(1):68–80CrossRefPubMedGoogle Scholar
  28. 28.
    Ata A, Lee J, Bestle SL et al (2010) Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg 145(9):858–864CrossRefPubMedGoogle Scholar
  29. 29.
    Serra-Aracil X, Garcia-Domingo MI, Pares D et al (2011) Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. Arch Surg 146(5):606–612CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • M. Gachabayov
    • 1
  • A. J. Senagore
    • 1
  • S. K. Abbas
    • 1
  • S. B. Yelika
    • 1
  • K. You
    • 1
  • R. Bergamaschi
    • 1
  1. 1.Division of Colon and Rectal Surgery, Health Sciences Center T18, Suite 046BState University of New YorkStony BrookUSA

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