Correlation Between Postoperative Hyperglycemia and the Occurrence of Surgical Site Infections After Surgery for Gastroenterological Malignancy: A Retrospective Analysis

Abstract

Background: Surgical site infection (SSI) is one of the most important complications after surgery for gastroenterological malignancy in that it leads to prolonged postoperative hospital stay and increased inpatient cost. Especially in case for malignancy, SSI sometimes delays the initiation of postoperative treatments including adjuvant chemotherapy and that can negatively affect prognosis.Methods: Patients with gastroenterological malignancy who underwent surgery in our institution were retrospectively reviewed and categorized according to the occurrence of incisional SSI; SSI group and no SSI group. The clinicopathological characteristics between two groups were compared, i.e. age, sex, body mass index, location of malignancy, results of postoperative blood examination, operation time, and amount of blood loss. Then, the same analysis was performed in the subpopulation that included colorectal cancer patients.Results: The 528 patients enrolled in the present study consisted of 330 males and 198 females of mean age 68 ± 11 years at the time of their operation. The numbers of patients with diseases of the esophagus, stomach, small intestine, colon and rectum, liver, gallbladder, and pancreas were 25, 150, 7, 255, 51, 5, and 35, respectively. Open surgery was performed in 303 patients and laparoscopic surgery in 225. Incisional SSI occurred in 46 patients (8.7%). Univariate analysis showed that postoperative hyperglycemia (serum glucose level ≥139 mg/dL within 24 h of operation) was the sole significant risk factor for incisional SSI (p=0.026). Multivariate analysis showed that postoperative hyperglycemia was an independent risk factor for incisional SSI (odds ratio 1.89, 95% confidence interval 1.009–3.614). In a subgroup analysis of patients who underwent colorectal surgery, the SSI occurred in 27 patients (10.5%). It also showed that postoperative hyperglycemia was a significant risk factor for incisional SSI (p=0.033), in addition to open surgery (p=0.024).Conclusions: Postoperative hyperglycemia was the independent risk factor for incisional SSI after surgery for gastroenterological malignancy. Prevention of postoperative hyperglycemia is important in achieving a decrease in the rate of incisional SSI.