Glycemic Control and Prevention of Surgical Site Infection

Kao, Lillian S.; Phatak, Uma R.

doi:10.1089/sur.2013.008

Cited by 31 publications

(18 citation statements)

References 87 publications

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“…This information can be used to discuss the most appropriate timing of breast reconstruction (immediate versus delayed) given the woman’s preferences and personal SSI risk. It can also be used to discuss personal risk reduction strategies (e.g., smoking cessation, losing weight before semi-elective reconstructive procedures, careful attention to glucose control and prevention of hyperglycemia 46 ) and guide use of preventive measures by physicians (e.g., home health post-discharge, delaying surgery to ensure resolution of preexisting infection, psychiatric referral for treatment of depression). Focusing additional preventive measures in the moderate and high-risk populations (SSI risk > 7.5%) would target 45% of the population, which would be more cost-effective for interventions such as post-discharge home health.…”

Section: Discussionmentioning

confidence: 99%

Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection After Mastectomy

et al. 2016

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Background Little data are available regarding individual patients’ risk of surgical site infection (SSI) following mastectomy with or without immediate reconstruction. Our objective was to develop a risk prediction model for mastectomy-related SSI. Methods We established a cohort of women < 65 years of age with mastectomy from 1/1/2004–12/31/2011 using commercial claims data. ICD-9-CM diagnosis codes were used to identify SSI within 180 days after surgery. SSI risk factors were determined with multivariable logistic regression using derivation data from 2004-2008 and validated with 2009–2011 data using discrimination and calibration measures. Results In the derivation cohort 595 SSIs were identified in 7,607 (7.8%) women, and 396 SSIs were coded in 4,366 (9.1%) women in the validation cohort. Independent risk factors for SSIs included rural residence, rheumatologic disease, depression, diabetes, hypertension, liver disease, obesity, preexisting pneumonia or urinary tract infection, tobacco use disorder, smoking-related diseases, bilateral mastectomy, and immediate reconstruction. Receipt of home health care was associated with lower risk. The model performed equally in the validation cohort per discrimination (C statistics 0.657 and 0.649) and calibration (Hosmer-Lemeshow P=0.091 and 0.462 for derivation and validation, respectively). Three risk strata were created based on predicted SSI risk, which demonstrated good correlation with the proportion of observed infections in the strata. Conclusions We developed and internally validated an SSI risk prediction model that can be used to counsel women concerning their individual risk of SSI post-mastectomy. Immediate reconstruction, diabetes, and smoking-related diseases were important risk factors for SSI in this nonelderly population of women undergoing mastectomy.

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Section: Discussionmentioning

confidence: 99%

Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection After Mastectomy

et al. 2016

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“…Several observational studies on different types of surgery have shown an association between hyperglycaemia and SSI, both in patients with and in those without diabetes. The first large RCT addressing this topic, in 2001, showed a significant reduction in mortality in patients in the ICU when tight glucose control was employed, but conflicting reports have been published since then.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection

Vries

Gans

Solomkin

et al. 2016

British Journal of Surgery

111

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Background: There is a clear association between hyperglycaemia and surgical-site infection (SSI). Intensive glucose control may involve a risk of hypoglycaemia, which in turn results in potentially severe complications. A systematic review was undertaken of studies comparing intensive versus conventional glucose control protocols in relation to reduction of SSI and other outcomes, including hypoglycaemia, mortality and stroke.Methods: PubMed, Embase, CENTRAL, CINAHL and WHO databases from 1 January 1990 to 1 August 2015 were searched. Inclusion criteria were RCTs comparing intensive with conventional glucose control protocols, and reporting on the incidence of SSI. Meta-analyses were performed with a random-effects model, and meta-regression was subsequently undertaken. Targeted blood glucose levels, achieved blood glucose levels, and important adverse events were summarized.Results: Fifteen RCTs were included. The summary estimate showed a significant benefit for an intensive compared with a conventional glucose control protocol in reducing SSI (odds ratio (OR) 0⋅43, 95 per cent c.i. 0⋅29 to 0⋅64; P < 0⋅001). A significantly higher risk of hypoglycaemic events was found for the intensive group compared with the conventional group (OR 5⋅55, 2⋅58 to 11⋅96), with no increased risk of death (OR 0⋅74, 0⋅45 to 1⋅23) or stroke (OR 1⋅37, 0⋅26 to 7⋅20). These results were consistent both in patients with and those without diabetes, and in studies with moderately strict and very strict glucose control. Conclusion:Stricter and lower blood glucose target levels of less than 150 mg/dl (8⋅3 mmol/l), using an intensive protocol in the perioperative period, reduce SSI with an inherent risk of hypoglycaemic events but without a significant increase in serious adverse events.

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“…(1)(2)(3)(4) Stress hyperglycemia, defined as acute short-term elevations in blood glucose levels during acute illness or trauma, has been associated with increased surgical site infections across multiple types of procedures and among patients with and without DM. (5,6) Poor long-term glycemic control, as measured by HbA1c, has also been associated with increased postoperative complications. (7)(8)(9)(10)(11) The last published guidelines from the Centers for Disease Control are from 1999 and recommend that practitioners "adequately control serum blood glucose levels in all diabetic patients and particularly avoid hyperglycemia perioperatively."…”

mentioning

confidence: 99%

“…Surgical site infections have been strongly associated with perioperative hyperglycemia in the literature, but surgical site infections only comprised 5% of major complications in our study. (6) On the other hand, other adverse events such as cardiac complications may be more related to HbA1c. (34) Furthermore, treatment of perioperative shortterm hyperglycemia may improve outcomes.…”

mentioning

confidence: 99%

Preoperative Glycosylated Hemoglobin and Postoperative Glucose Together Predict Major Complications after Abdominal Surgery

Goodenough

Liang

Nguyen

et al. 2015

Journal of the American College of Surgeons

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Glycemic Control and Prevention of Surgical Site Infection

Cited by 31 publications

References 87 publications

Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection After Mastectomy

Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection After Mastectomy

Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection

Preoperative Glycosylated Hemoglobin and Postoperative Glucose Together Predict Major Complications after Abdominal Surgery

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