American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update

Ban, Kristen A.; Minei, Joseph P.; Laronga, Christine; Harbrecht, Brian G.; Jensen, Eric H.; Fry, Donald E.; Itani, Kamal M.F.; Dellinger, E. Patchen; Ko, Clifford Y.; Duane, Therèse M.

doi:10.1016/j.jamcollsurg.2016.10.029

Cited by 725 publications

(718 citation statements)

References 134 publications

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“…reported that a glucose level >140 mg/dL was the only significant risk factor associated with SSI in patients undergoing colorectal surgery. Meta‐analysis23 confirmed the benefits of an intensive protocol targeting <150 mg/dL for reducing SSI, and recent guidelines7 recommended that perioperative glycemic control should be between 110 and 150 mg/dL. A dose–response relationship between BG level and SSI rate was reported in general surgery patients 14.…”

Section: Relationship Between Perioperative Bg and Ssi In Patients Whmentioning

confidence: 78%

“…The CDC members of the WHO guidelines panel decided that the available evidence did not allow the definition of an optimal target BG, and emphasized that hypoglycemia associated with intensive protocols carries a serious risk of life‐threatening complications 6. By contrast, the guidelines by the American College of Surgeons (ACS) and Surgical Infection Society (SIS)7 specified the optimal target BG, and recommended that perioperative glycemic control should be between 110 and 150 mg/dL (moderately strict control) except in cardiac surgery patients for whom the target is <180 mg/dL, because a target BG of <110 mg/dL has been linked to adverse outcomes and increased episodes of hypoglycemia and do not decrease SSI risk compared with moderately strict control.…”

Section: Indication For Intensive Protocol In Critically Ill Patientsmentioning

confidence: 99%

“…These findings strongly support the monitoring of BG level and early consideration of management strategies for glycemic control after surgery, even in non‐DM patients. Guidelines by WHO6 and ACS/SIS7 suggest an intensive protocol for both DM and non‐DM adult patients undergoing surgical procedures to reduce the risk of SSI.…”

Section: Relationship Between Perioperative Bg and Ssi In Patients Whmentioning

confidence: 99%

“…In addition, the stress response to surgical insult results in insulin tolerance, and decreased pancreatic beta‐cell function causes hypo‐insulinemia, augmenting stress‐induced hyperglycemia 2. For the prevention of surgical site infections (SSI), appropriate perioperative insulin therapy is required in patients with hyperglycemia 3, 4, 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

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Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Takesue

Tsuchida

2017

Annals of Gastroent Surgery

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Perioperative hyperglycemia is a risk factor for surgical site infections (SSI). Although the recommended target blood glucose level (BG) is 140–180 mg/dL for critically ill patients, recent studies conducted in patients undergoing surgery showed a significant benefit of intensive insulin therapy for the management of perioperative hyperglycemia. The aim of the present review is to evaluate the benefits of strict glycemic control for reducing SSI in gastroenterological surgery. We carried out a post‐hoc analysis of the previously published data from research on the risk factors for SSI. The highest BG within 24 hours after surgery was evaluated. A total of 1555 patients were enrolled in the study. In multivariate analysis, a dose–response relationship between the level of hyperglycemia and the odds of SSI was demonstrated when compared with the reference group (≤150 mg/dL) (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.14–2.49 for 150–200 mg/dL; and OR = 2.15, 95% CI 1.40–3.29 for >200 mg/dL). Unexpectedly, hyperglycemia was not a significant risk factor for SSI among diabetes patients. By contrast, non‐diabetes patients with a BG of >150 mg/dL were found to have increased odds of SSI. In conclusion, a target BG of ≤150 mg/dL is recommended in patients without diabetes who undergo gastroenterological surgery. Additional study is required to determine an optimal target BG in diabetes patients. Because of the risk of hypoglycemia, a conventional protocol is indicated for patients admitted to the general ward where frequent glucose measurement is not assured.

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Section: Relationship Between Perioperative Bg and Ssi In Patients Whmentioning

confidence: 78%

Section: Indication For Intensive Protocol In Critically Ill Patientsmentioning

confidence: 99%

Section: Relationship Between Perioperative Bg and Ssi In Patients Whmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Takesue

Tsuchida

2017

Annals of Gastroent Surgery

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show abstract

“…7 Most guidelines, including Therapeutic Guidelines: Antibiotic, recommend that preoperative intravenous antibiotics be given within 60 minutes of incision. 3,8,14,[31][32][33][34] More recently, the World Health Organization recommended administration within 120 minutes of incision. 35 For caesarean sections, evidence supports antimicrobial prophylaxis before cord clamping rather than afterwards.…”

Section: Resultsmentioning

confidence: 99%