Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: Results from the Michigan surgical quality collaborative database

Mohan S, Kaoutzanis C, Welch KB, Vandewarker JF, Winter S, Krapohl G, Lampman RM, Franz MG, Cleary RK

"Following colorectal operations, superficial SSI, sepsis, and death are associated with postoperative serum hyperglycemia in patients without diabetes, but not those with diabetes. Vigilant postoperative BG monitoring is critical for all patients undergoing colorectal surgery."

Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCO-CABG trial

Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M, Newton CA, Smiley-Byrd D, Vellanki P, Halkos M, Puskas JD, Guyton RA, Thourani VH

"Intensive insulin therapy to target glucose of 100 and 140 mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180 mg/dL after CABG surgery. Subgroup analysis showed a lower number of complications in patients without diabetes, but not in patients with diabetes treated with the intensive regimen. Large prospective randomized studies are needed to confirm these findings."

The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: A systematic review

Boreland L, Scott-Hudson M, Hetherington K, Frussinetty A, Slyer JT

"Maintaining blood glucose levels = 200 mg/dL with a continuous insulin infusion in all stages of the perioperative period in cardiac surgery patients with diabetes can reduce the incidence of surgical site infections."

The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: A systematic review

Boreland L, Scott-Hudson M, Hetherington K, Frussinetty A, Slyer JT

"Maintaining blood glucose levels ≤ 200 mg/dL with a continuous insulin infusion in all stages of the perioperative period in cardiac surgery patients with diabetes can reduce the incidence of surgical site infections."

Short-term glycemic control is effective in reducing surgical site infection in diabetic rats

Kroin JS, Buvanendran A, Li J, Moric M, Im HJ, Tuman KJ, Shafikhani SH

"A short-term glycemic control regimen, initiated just before surgery and bacterial exposure, was as effective in reducing surgical site infection as a long-term glycemic control in type 1 diabetic rats. These data suggest that immediately implementing glycemic control in type 1 diabetic surgical patients before undergoing noncardiac surgery may decrease the risk of infection."

Do glycemic markers predict occurrence of complications after total knee arthroplasty in patients with diabetes?

Hwang JS, Kim SJ, Bamne AB, Na YG, Kim TK

"In general, there is a positive correlation among the various available glycemic markers among patients with diabetes undergoing [Total Knee Arthrplasty], and patients undergoing surgery with HbA1c ≥ 8 and/or FBG ≥ 200 mg/dL were associated with superficial surgical site infection. These findings should be considered in patient selection and preoperative counseling for patients with diabetes undergoing TKA."

Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients

Al-Niaimi AN, Ahmed M, Burish N, Chackmakchy SA, Seo S, Rose S, Hartenbach E, Kushner DM, Safdar N, Rice L, Connor J

"Initiating intensive glycemic control for 24h after gynecologic oncology surgery in patients with [diabetes mellitus] and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics."

Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery

Wukich DK, Crim BE, Frykberg RG, Rosario BL

"Complicated diabetes increases the risk of surgical site infection after foot and ankle surgery. Patients who had diabetes without complications did not have a greater risk of surgical site infection compared with nondiabetic patients without neuropathy. The presence of neuropathy increases the risk of surgical site infection even in patients without diabetes. Poor long-term glycemic control is also associated with an increased risk of surgical site infection."

Stress hyperglycemia and surgical site infection in stable nondiabetic adults with orthopedic injuries

Richards JE, Hutchinson J, Mukherjee K, Jahangir AA, Mir HR, Evans JM, Perdue AM, Obremskey WT, Sethi MK, May AK

"Stress hyperglycemia was associated with SSI in this prospective observational cohort of stable nondiabetic patients with orthopedic injuries. Further prospective randomized studies are necessary to identify optimal treatment of hyperglycemia in the noncritically ill trauma population."

High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery

Hikata T, Iwanami A, Hosogane N, Watanabe K, Ishii K, Nakamura M, Kamata M, Toyama Y, Matsumoto M

"[Diabetes Mellitus] patients whose blood glucose levels were poorly controlled before surgery were at high risk for SSI. To prevent SSI in DM patients, we recommend lowering the HbA1c to <7.0 % before performing surgery."

Glycemic control and prevention of surgical site infection

Kao LS, Phatak UR

"Current recommendations for glycemic control in surgical patients are informed primarily by trials using intensive insulin therapy in critically ill patients. Further research is necessary to ascertain the optimal glycemic target for non-critically ill patients, to determine if subsets of patients may benefit from strict glycemic control, and to identify alternative methods for treating stress hyperglycemia and explaining the mechanisms by which it increases infectious risk."

Importance of perioperative glycemic control in general surgery: A report from the surgical care and outcomes assessment program

Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D

"Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than those with normal blood glucoses. Perioperative glucose evaluation and insulin administration in patients with hyperglycemia are important quality targets."

Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery)

Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, Umpierrez D, Newton C, Olson D, Rizzo M

A randomized multicenter trial of 211 patients with type 2 diabetes mellitus undergoing general surgery compared postoperative complications following a basal-bolus insulin regimen with glargine once daily and glulisine before meals versus a sliding scale regular insulin four times daily regimen. The study found that the basal-bolus treatment improved glycemic control and reduced hospital complications compared with the sliding scale regular insulin treatment.

Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients

Ata A, Lee J, Bestle SL, Desemone J, Stain SC

A retrospective medical record review of the postoperative glucose levels of 1,561 patients undergoing general and vascular surgery found that incremental postoperative glucose level was a significant predictor of SSI. Surgical site infection incidences can be reduced through aggressive early postoperative glycemic control.

Risk factors and predictors for surgical site infection after hepatic resection

Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Yatabe T, Maeda H, Kobayashi M, Hanazaki K

A study of 152 patients who underwent liver resection demonstrated that a lack of postoperative glycemic control was associated with a significantly higher incidence of postoperative infectious complications and longer hospitalization.

Peri-operative glycaemic control regimens for preventing surgical site infections in adults

Kao LS, Meeks D, Moyer VA, Lally KP

From a review of five randomized, controlled trials, only one trial showed a significant surgical site infection reduction with strict glycemic control. Results suggest there is insufficient evidence to support strict glycemic control versus conventional management, and there is a need for further large randomized trials.