Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery

Selwyn O. Rogers, Margarita Ramos, Zain Khalpey, Stuart Lipsitz, Jill Steinberg, Maria Theresa Panizales, Michael Zinner

Research output: Contribution to journalArticle

208 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)585-590
Number of pages6
JournalAnnals of Surgery
Volume248
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

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Hyperglycemia
Blood Vessels
Infection
Glucose
Critical Illness
Hospitalization
Retrospective Studies
Population

ASJC Scopus subject areas

  • Surgery

Cite this

Rogers, S. O., Ramos, M., Khalpey, Z., Lipsitz, S., Steinberg, J., Panizales, M. T., & Zinner, M. (2008). Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Annals of Surgery, 248(4), 585-590. https://doi.org/10.1097/SLA.0b013e31818990d1

Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. / Rogers, Selwyn O.; Ramos, Margarita; Khalpey, Zain; Lipsitz, Stuart; Steinberg, Jill; Panizales, Maria Theresa; Zinner, Michael.

In: Annals of Surgery, Vol. 248, No. 4, 10.2008, p. 585-590.

Research output: Contribution to journalArticle

Rogers, SO, Ramos, M, Khalpey, Z, Lipsitz, S, Steinberg, J, Panizales, MT & Zinner, M 2008, 'Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery', Annals of Surgery, vol. 248, no. 4, pp. 585-590. https://doi.org/10.1097/SLA.0b013e31818990d1
Rogers, Selwyn O. ; Ramos, Margarita ; Khalpey, Zain ; Lipsitz, Stuart ; Steinberg, Jill ; Panizales, Maria Theresa ; Zinner, Michael. / Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. In: Annals of Surgery. 2008 ; Vol. 248, No. 4. pp. 585-590.
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AU - Rogers, Selwyn O.

AU - Ramos, Margarita

AU - Khalpey, Zain

AU - Lipsitz, Stuart

AU - Steinberg, Jill

AU - Panizales, Maria Theresa

AU - Zinner, Michael

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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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