Diabetes and Risk of Surgical Site Infection: A Narrative Review

Abstract

Background: Diabetes Mellitus (DM) significantly elevates the risk of surgical site infections (SSIs), a major postoperative complication that increases morbidity, prolongs hospital stay, and escalates healthcare costs. The complex interplay between hyperglycemia-induced immunosuppression, impaired wound healing, and the increased propensity for infections in diabetic patients underscores the need for a comprehensive understanding of the mechanisms at play and effective management strategies. Objective: This narrative review aims to synthesize current evidence on the relationship between DM and the risk of SSIs, emphasizing the pathophysiological mechanisms, the impact of glycemic control on surgical outcomes, and the role of advanced surgical techniques in mitigating this risk. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published up to April 2023, using keywords related to DM, SSIs, and perioperative management. Inclusion criteria targeted studies on the association between DM and SSIs, focusing on outcomes in diabetic versus non-diabetic patients, and the effectiveness of glycemic control. Data extraction and synthesis were performed using a narrative approach, with quality assessment based on study design-specific appraisal tools. Results: The review highlights that diabetic patients exhibit a significantly higher risk of developing SSIs compared to non-diabetic individuals, attributed to impaired immune response, microvascular complications, and delayed wound healing associated with hyperglycemia. Effective preoperative and postoperative glycemic control, maintaining hemoglobin A1c (HbA1c) levels below 7%, has been shown to reduce the incidence of SSIs. Furthermore, advancements in minimally invasive surgical techniques have contributed to lower SSI rates by reducing tissue trauma and preserving immune function. Conclusion: Diabetes mellitus is a significant risk factor for surgical site infections, underscoring the importance of stringent glycemic control and the adoption of advanced surgical techniques in the perioperative management of diabetic patients. Future research should focus on refining glycemic control strategies, understanding the genetic and molecular mechanisms underlying increased SSI risk, and developing targeted therapies to improve surgical outcomes in this high-risk population.