TY - JOUR
T1 - Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery
AU - Rogers, Selwyn O.
AU - Ramos, Margarita
AU - Khalpey, Zain
AU - Lipsitz, Stuart
AU - Steinberg, Jill
AU - Panizales, Maria Theresa
AU - Zinner, Michael
PY - 2008/10
Y1 - 2008/10
N2 - Objective: Evaluate the association of perioperative hyperglycemia and postoperative infections (POI) in patients who had undergone general surgery. Background: Intensive glucose control leads to less postoperative infections (POI) in critically ill surgical patients, but the relationship of hyperglycemia and POI in a general surgical population remains unknown. Methods: A retrospective study of 995 patients who had undergone general and vascular surgery investigated the association of perioperative acute hyperglycemia and risk of 30-day POI over an 18-month period. The primary predictor of interest was postoperative glucose (POG). Bivariate analyses determined the association of each independent variable with POI. Factors significant at P < 0.05 were used in multivariable logistic regression models. Results: In bivariate analyses, preoperative blood glucose (P = 0.012), POG (P = 0.009), age (P = 0.002), diabetes (P = 0.04), American Society of Anesthesia Classification (ASAC) (P < 0.0001), operation length (P = 0.02), and blood transfusions (P = 0.02) were significant predictors of POI. In multivariate analyses, only POG (OR = 1.3, (1.03-1.64)), ASAC (OR = 1.9, (1.31-2.83)), and emergency status (OR = 2.2, (1.21-3.80)) remained significant predictors of POI. Postoperative hyperglycemia increased the risk of POI by 30% with every 40-point increase from normoglycemia (<110 mg/dL). Longer hospitalization was also observed for patients with POG from 110 to 200 mg/dL (OR = 1.4, (1.1-1.7)) and >200 mg/dL (OR = 1.8, (1.4-2.5)). Conclusion: The increased risk of POI and length of hospitalization posed by postoperative hyperglycemia is independent of diabetic status and needs further evaluation to assess for possible benefits of postoperative glycemic control in patients who have undergone general surgery.
AB - Objective: Evaluate the association of perioperative hyperglycemia and postoperative infections (POI) in patients who had undergone general surgery. Background: Intensive glucose control leads to less postoperative infections (POI) in critically ill surgical patients, but the relationship of hyperglycemia and POI in a general surgical population remains unknown. Methods: A retrospective study of 995 patients who had undergone general and vascular surgery investigated the association of perioperative acute hyperglycemia and risk of 30-day POI over an 18-month period. The primary predictor of interest was postoperative glucose (POG). Bivariate analyses determined the association of each independent variable with POI. Factors significant at P < 0.05 were used in multivariable logistic regression models. Results: In bivariate analyses, preoperative blood glucose (P = 0.012), POG (P = 0.009), age (P = 0.002), diabetes (P = 0.04), American Society of Anesthesia Classification (ASAC) (P < 0.0001), operation length (P = 0.02), and blood transfusions (P = 0.02) were significant predictors of POI. In multivariate analyses, only POG (OR = 1.3, (1.03-1.64)), ASAC (OR = 1.9, (1.31-2.83)), and emergency status (OR = 2.2, (1.21-3.80)) remained significant predictors of POI. Postoperative hyperglycemia increased the risk of POI by 30% with every 40-point increase from normoglycemia (<110 mg/dL). Longer hospitalization was also observed for patients with POG from 110 to 200 mg/dL (OR = 1.4, (1.1-1.7)) and >200 mg/dL (OR = 1.8, (1.4-2.5)). Conclusion: The increased risk of POI and length of hospitalization posed by postoperative hyperglycemia is independent of diabetic status and needs further evaluation to assess for possible benefits of postoperative glycemic control in patients who have undergone general surgery.
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U2 - 10.1097/SLA.0b013e31818990d1
DO - 10.1097/SLA.0b013e31818990d1
M3 - Article
C2 - 18936571
AN - SCOPUS:55449125205
SN - 0003-4932
VL - 248
SP - 585
EP - 590
JO - Annals of surgery
JF - Annals of surgery
IS - 4
ER -