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

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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.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Health Sciences Center T18, Suite 046B, State University of New York, 101 Nicolls Road, Stony Brook, NY, 11794, USA

    M. Gachabayov, A. J. Senagore, S. K. Abbas, S. B. Yelika, K. You & R. Bergamaschi

Authors
  1. M. Gachabayov
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  2. A. J. Senagore
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  3. S. K. Abbas
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  4. S. B. Yelika
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  5. K. You
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  6. R. Bergamaschi
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Corresponding author

Correspondence to R. Bergamaschi.

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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.

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Gachabayov, M., Senagore, A.J., Abbas, S.K. et al. Perioperative hyperglycemia: an unmet need within a surgical site infection bundle. Tech Coloproctol 22, 201–207 (2018). https://doi.org/10.1007/s10151-018-1769-2

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  • DOI: https://doi.org/10.1007/s10151-018-1769-2

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