Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis

Abstract

Objective To determine the independent association between diabetes and SSI across multiple surgical procedures. Design Systematic review and meta-analysis. Methods Studies indexed in PubMed published between December 1985 and through July 2015 were identified through the search terms “risk factors” or “glucose” and “surgical site infection”. A total of 3,631 abstracts were identified through the initial search terms. Full texts were reviewed for 522 articles. Of these, 94 articles met the criteria for inclusion. Standardized data collection forms were used to extract study-specific estimates for diabetes, blood glucose levels, and body mass index (BMI). Random-effects meta-analysis was used to generate pooled estimates and meta-regression was used to evaluate specific hypothesized sources of heterogeneity. Results The primary outcome was SSI, as defined by the Centers for Disease Control and Prevention surveillance criteria. The overall effect size for the association between diabetes and SSI was OR=1.53 (95% Predictive Interval 1.11, 2.12, I2: 57.2%). SSI class, study design, or patient BMI did not significantly impact study results in a meta-regression model. The association was higher for cardiac surgery 2.03 (95% Predictive Interval 1.13, 4.05) compared to surgeries of other types (p=0.001). Conclusion These results support the consideration of diabetes as an independent risk factor for SSIs for multiple surgical procedure types. Continued efforts are needed to improve surgical outcomes for diabetic patients.

Post Cesarean Section Surgical Site Infection; Incidence and Risk Factors

“…Also; for each patient, either in diseased or control group; there had been some specific information collected such as: age, parity, address (to document if woman was native or Fasting blood sugar measurements were documented at time of CS, and diabetes mellitus was diagnosed when it exceeded 105 mg/dl. [20] Body mass index (BMI) was calculated for all patients depending on their height and weight. We divided BMI readings into two categories; either < 30 (non-obese) or ≥30 (obese).…”

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

“…As patients with DM have a higher risk of cardiovascular disease, and the association with SSI was significantly higher for cardiac surgery compared with other surgeries in DM patients21 (OR 2.03, 95% confidence interval [CI] 1.13–4.05), many of the available studies evaluating the efficacy of glycemic control on SSI were limited to cardiac surgery patients,22 which raised questions about the generalizability of the results to patients undergoing other surgical procedures 12. Vigorous studies have been recently conducted to clarify the efficacy of tight (strict) glycemic control in patients undergoing gastroenterological surgery, and four of 15 randomized clinical trials (RCT) comparing intensive with conventional protocols were carried out in patients undergoing abdominal surgery (nine were conducted for cardiac surgery) 23.…”

“…Systematic review and meta‐analysis addressed a significant association between DM and SSI,21 and hyperglycemia in DM patients who undergo surgery is associated with increased rates of SSI. Although non‐DM patients had a lower incidence and decreased severity of hyperglycemia compared with DM patients, hyperglycemia was also associated with adverse outcomes in non‐DM patients 13, 16, 17.…”

Robotic Versus Open Renal Transplantation in Obese Patients: Protocol for a Cost-Benefit Markov Model Analysis (Preprint)

“…Obese patients have a higher prevalence of diabetes that is a predisposing factor for delayed wound healing and to bacterial infections [23][24][25][26]. In addition, due to the extra-adipose tissue in the subcuticular space, obese patiens are prone to develop seromas that often become infected because of the suboptimal vascularization of the adipose tissue [27][28][29][30].…”