Effect of perioperative hyperglycemia on surgical site infection in abdominal surgery: A prospective cohort study

Bellusse, Gislaine Cristhina; Ribeiro, Julio Cesar; Freitas, Isabel Cristina Martins de; Galvão, Cristina María

doi:10.1016/j.ajic.2019.11.009

Cited by 16 publications

(18 citation statements)

References 20 publications

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“…Patients with diabetes, both diagnosed and undiagnosed, who require surgery have higher risks of requiring prolonged postoperative ventilation and critical care, as well as complications, longer lengths of stay, and mortality. Although hyperglycemia is a major risk factor for SSI after open abdominal surgery [31], this association has been less consistently observed in study populations enriched with patients undergoing MIS, including colon operations [32]. Still, there is increasing evidence that hyperglycemia is an easily identifiable, modifiable risk factor that should be addressed in optimizing patients for surgical intervention.…”

Section: Hyperglycemiamentioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

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This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.

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Section: Hyperglycemiamentioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

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show abstract

“…However, there was no signi cant risk factor. Diabetes mellitus and uncontrolled blood glucose are well-known risk factors of SSI [21]. Although the detailed underlying disease could not be known in this study, SSI incidence did not show a signi cant relationship with the ASA score in re ecting the patient's underlying disease and severity.…”

Section: Discussionmentioning

confidence: 55%

Impact of wound irrigation during laparoscopic appendectomy on surgical site infection in acute appendicitis: a multicenter retrospective analysis

Nam¹,

Park²,

Chin-Ock³

2020

Preprint

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Background Surgical site infection (SSI) is one of the major complications after appendectomy. Among the many efforts to reduce variable risk factors, subcutaneous wound irrigation has been reported in some abdominal surgeries. However, there are no relevant literatures regarding patients who underwent laparoscopic appendectomy. This study aimed to determine the effect of wound irrigation before skin closure when performing laparoscopic appendectomy. Methods We included patients who had undergone laparoscopic appendectomy due to acute appendicitis from March 2017 to October 2019 from three hospitals. Clinical data of 333 patients were retrospectively collected, and we divided 333 patients into three groups according to the method of wound irrigation: no irrigation (n = 93), saline irrigation (n = 144), and povidone-iodine (PI) (n = 96) groups. Results A total of 15 patients (4.5%) were diagnosed with SSI within postoperative 30 days. There was no difference in the SSI rates (4.3% vs. 5.1% vs. 4.5%, p = 0.953). None of the factors were associated with SSI among the variables (sex, age, ASA, perforated appendicitis, preoperative WBC and hemoglobin levels, operation time, wound irrigation, type of wound closure material, and preoperative and postoperative fever). Conclusions Wound irrigation did not affect the SSI rate in patients who underwent laparoscopic appendectomy.

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“…For example, of the seven observational studies in orthopaedic surgery published in the last decade that examined hyperglycaemia and postoperative outcome in people with and without diabetes, all analysed those with and without the condition together. These types of analyses are also present in all studies in head and neck [15], thoracic [16], hepatobiliary [17–19] and neurosurgery [20, 21] and in the majority of papers in cardiac [22–31], lower [32–34] and upper [34, 35] gastro‐intestinal surgery. People with diabetes have increased risk of cardiovascular, renal, ophthalmic and neurological morbidities.…”

Section: Discussionmentioning

confidence: 98%

“…hepatobiliary [17][18][19] and neurosurgery [20,21] and in the majority of papers in cardiac [22][23][24][25][26][27][28][29][30][31], lower [32][33][34] and upper [34,35] gastro-intestinal surgery. People with diabetes have increased risk of cardiovascular, renal, ophthalmic and neurological morbidities.…”

Section: Discussionmentioning

confidence: 99%

Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population‐based study in UK Biobank

et al. 2022

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Summary The aim of our study was to clarify the association between glycated haemoglobin (HbA1c) and postoperative outcomes in people without an existing diagnosis of diabetes. Half a million adults were recruited into the UK Biobank prospective cohort study between March 2006 and October 2010. We divided participants into three groups: no diagnosis of diabetes and HbA1c < 42 mmol.mol−1; no diagnosis of diabetes and elevated HbA1c (≥ 42 mmol.mol−1 with no upper limit); and prevalent diabetes (regardless of HbA1c concentration) at recruitment. We followed up participants by linkage with routinely collected hospital data to determine any surgical procedures undertaken after recruitment and the associated postoperative outcomes. Our main outcome measure was a composite primary outcome of 30‐day major postoperative complications and 90‐day all‐cause mortality. We used logistic regression to estimate the odds of the primary outcome by group. We limited analyses to those who underwent surgery within one year of recruitment (n = 26,653). In a combined effects logistic regression model, participants not known to have diabetes with HbA1c ≥ 42 mmol.mol−1 had increased odds of the primary outcome (OR [95% CI] 1.43 [1.02–2.02]; p = 0.04), when compared with those without diabetes and HbA1c < 42 mmol.mol−1. This effect was attenuated and no longer statistically significant in a direct effects model with adjustment for hyperglycaemia‐related comorbidity (OR [95% CI] 1.37 [0.97–1.93]; p = 0.07). Elevated pre‐operative HbA1c in people without diabetes may be associated with an increased risk of complications, but the association is likely confounded by end‐organ comorbidity. In contrast to previous evidence, our findings suggest that to prevent adverse postoperative outcomes, optimisation of pre‐existing morbidity should take precedence over reducing HbA1c in people without diabetes.

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Effect of perioperative hyperglycemia on surgical site infection in abdominal surgery: A prospective cohort study

Cited by 16 publications

References 20 publications

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Impact of wound irrigation during laparoscopic appendectomy on surgical site infection in acute appendicitis: a multicenter retrospective analysis

Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population‐based study in UK Biobank

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