Diabetes mellitus is associated with increased risk of surgical site infections: A meta-analysis of prospective cohort studies

Zhang, Yu; Zheng, Qiujian; Wang, Sheng; Zeng, Shixing; Zhang, Youping; Bai, Xin; Hou, Tieying

doi:10.1016/j.ajic.2015.04.003

Cited by 52 publications

(33 citation statements)

References 41 publications

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“…Multiple studies have shown that diabetes is a significant risk factor for infection [28]. Furthermore, good glycemic control perioperatively has been shown to reduce surgical site infections [29].…”

Section: Discussionmentioning

confidence: 99%

The relationship between diabetes mellitus and 30-day readmission rates

Ostling

Wyckoff

Ciarkowski

et al. 2017

Clin Diabetes Endocrinol

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BackgroundIt is estimated that 9.3% of the population in the United States have diabetes mellitus (DM), 28% of which are undiagnosed. The high prevalence of DM makes it a common comorbid condition in hospitalized patients. In recent years, government agencies and healthcare systems have increasingly focused on 30-day readmission rates to determine the complexity of their patient populations and to improve quality. Thirty-day readmission rates for hospitalized patients with DM are reported to be between 14.4 and 22.7%, much higher than the rate for all hospitalized patients (8.5–13.5%). The objectives of this study were to (1) determine the incidence and causes of 30-day readmission rates for patients with diabetes listed as either the primary reason for the index admission or with diabetes listed as a secondary diagnosis compared to those without DM and (2) evaluate the impact on readmission of two specialized inpatient DM services: the Hyperglycemic Intensive Insulin Program (HIIP) and Endocrine Consults (ENDO).MethodsFor this study, DM was defined as any ICD-9 discharge diagnosis (principal or secondary) of 250.xx. Readmissions were defined as any unscheduled inpatient admission, emergency department (ED) visit, or observation unit stay. We analyzed two separate sets of patient data. The first pilot study was a retrospective chart review of all patients with a principle or secondary admission diagnosis of diabetes admitted to any adult service within the University of Michigan Health System (UMHS) between October 1, 2013 and December 31, 2013. We then did further uncontrolled analysis of the patients with a principal admitting diagnosis of diabetes. The second larger retrospective study included all adults discharged from UMHS between October 1, 2013 and September 30, 2014 with principal or secondary discharge diagnosis of DM (ICD-9-CM: 250.xx).ResultsIn the pilot study of 7763 admissions, the readmission rate was 26% for patients with DM and 22% for patients without DM. In patients with a primary diagnosis of DM on index admission, the most common cause for readmission was DM-related. In the larger study were 37,702 adult inpatient discharges between October 1, 2013 and September 30, 2014. Of these, 20.9% had DM listed as an encounter diagnosis. Rates for all encounters (inpatient, ED and Observation care) were 24.3% in patients with DM compared to 17.7% in those without DM (p < 0.001). The most common cause for readmission in patients with DM as a secondary diagnosis to the index admission was infection-related.During the index hospital stay, only a small proportion of patients with DM (approximately 12%) received any DM service consult. Those who received a DM consult had a higher case mix index compared to those who did not. Despite the higher acuity, there was a lower rate of ED /observation readmission in patients followed by the DM services (6.6% HIIP or ENDO vs. 9.6% no HIIP or ENDO, p = 0.0012), though no difference in the inpatient readmission rates (17.6% HIIP or ENDO vs. 17.4% no HIIP or ENDO, p = 0...

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Section: Discussionmentioning

confidence: 99%

The relationship between diabetes mellitus and 30-day readmission rates

Ostling

Wyckoff

Ciarkowski

et al. 2017

Clin Diabetes Endocrinol

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“…Diabetes has been identified by a systematic review and meta-analysis as an independent risk factor for SSI in a number of surgical procedures including spinal surgeries. 28,29 Though the precise mechanism by which diabetes increases surgical complication risk is not agreed upon, it has been suggested that hyperglycemia during or after surgery may be responsible. 28 However, a number of studies have indicated that diabetes may also act to increase risk for surgical complications through its role in instigating secondary conditions such as vascular changes and white cell dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Medical and Surgical Complications Following Single-Level ALIF

Choy

Barrington

García

et al. 2017

Global Spine Journal

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Study Design:Retrospective cohort study.Objective:The objective of the study was to determine rates of medical and surgical postoperative complications following anterior lumbar interbody fusion (ALIF) along with their associated predictors.Methods:Using the American College of Surgeons National Surgical Quality Improvement database, patients who underwent single-level ALIF surgery from 2006 to 2013 were identified. The 30-day rate of postoperative medical and surgical complications along with associated risk factors were evaluated by multivariable logistic regression.Results:In total, 1474 patients were included in the analysis. The overall rate of complications was 14.5%. The medical complication rate was 12.7%, while the surgical complication rate was 2.8%. Predictors of surgical complications were diabetes (odds ratio [OR] = 2.79, 95% CI = 1.20-6.01, P = .009), corticosteroid dependence (OR = 4.94, 95% CI = 1.73-14.08, P = .003), and preoperative transfusion of >4 units (OR = 7.12, 95% CI = 1.43-35.37, P = .016). Predictors of medical complications were longer operative times (OR = 4.25, 95% CI = 2.90-6.24, P < .001), preoperative anemia (OR = 2.29, 95% CI = 1.50-3.50, P < .001), >10% weight loss prior to surgery (OR = 6.79, 95% CI = 1.01-45.93, P = .049), and more severe American Society of Anesthesiologists classification (OR = 2.18, 95% CI = 1.54-3.11, P < .001).Conclusions:The present study determines postoperative medical and surgical complications among patients undergoing ALIF. The risk factors elucidated in this study indicate that clinical practices to curtail complications should be targeted toward patients with preoperative anemia, weight loss, corticosteroid dependence, and toward those at risk for perioperative transfusions.

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“…The risk factors in our study (female sex, DM and COPD) are factors that cannot be influenced and are not related to [12,13,36,37]. It is therefore likely that they remain risk factors for infection in future IFN-containing CHC regimes, thus these patients should be monitored carefully for infection during any PegIFN based regime.…”

Section: Discussionmentioning

confidence: 99%

High Risk of Infection During Triple Therapy with First- Generation Protease Inhibitors: A Nationwide Cohort Study

Berden

Zwietering

Maan

et al. 2016

JGLD

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Background & Aims: Peginterferon (PegIFN) remains the backbone of therapy for chronic hepatitis C (CHC) in economically constrained regions. However, PegIFN may cause neutropenia and addition of a protease inhibitor can increase the likelihood of neutropenia. The aims of this study were to assess the occurrence of clinically relevant infections during first-generation protease inhibitor based therapy and its risk factors as well as the relation to treatment-induced neutropenia. Methods: This multicenter (n=45) retrospective cohort study included CHC patients treated in the Netherlands. Based on absolute neutrophil count, categories of neutropenia were defined as: severe (<500/μL), moderate (500-750/μL) and mild (750-1500/μL). Likewise, infections were classified as severe (intravenous antibiotics/ hospitalization) and moderate (anti-infective treatment). We assessed risk factors for infections using multivariable regression analysis adjusting for multiple measurements. Results: We included 467 CHC patients, 319 (68%) were male and 111 (24%) had cirrhosis. A total of 185 clinically relevant infections (34 severe) occurred in 145 patients (31%). During treatment 310 patients experienced neutropenia (severe, n=34). Multivariable analysis identified female sex (OR 1.7, 95%CI 1.2- 2.5), chronic obstructive pulmonary disease (COPD) (OR 2.7, 95%CI 1.6- 4.5) and diabetes mellitus (OR 1.7, 95%CI 1.0-3.0) as risk factors for infections. Neutropenia at the previous visit was not associated with infection (univariable analysis: OR 0.9, 95%CI 0.6-1.3). Conclusion: This study shows that therapy with first generation protease inhibitors was complicated by an infection in 31% of patients. Not neutropenia, but female sex, COPD and diabetes mellitus were independent risk factors for infection. These patients should be monitored carefully once a PegIFN regimen is initiated. Abbreviations: ANC: absolute neutrophil count; CHC: chronic hepatitis C; COPD: chronic obstructive pulmonary disease; DAAs: direct acting antivirals; DM: diabetes mellitus; HCV: hepatitis C virus; PegIFN: pegylated interferon alpha; PI: protease inhibitor; UTI: urinary tract infection.

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Diabetes mellitus is associated with increased risk of surgical site infections: A meta-analysis of prospective cohort studies

Cited by 52 publications

References 41 publications

The relationship between diabetes mellitus and 30-day readmission rates

The relationship between diabetes mellitus and 30-day readmission rates

Risk Factors for Medical and Surgical Complications Following Single-Level ALIF

High Risk of Infection During Triple Therapy with First- Generation Protease Inhibitors: A Nationwide Cohort Study

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