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Diabetes Increases Risk of Surgical Site Infections

A meta-analysis reveals that the risk is present for most surgeries.

A published meta-analysis and systematic review reveals that diabetic patients are at an increased risk of having post-surgery surgical site infections for the majority of surgeries. The review included 94 published studies from 1985 to 2015. Of the studies, 91 were observational and 3 were randomized controlled trials. None of the studies differentiated between T1DM and T2DM.

The primary outcome the study looked at was surgical site infection (SSI), as defined by the Centers for Disease Control and Prevention surveillance criteria. The association between diabetes and SSI was an odds ratio of 1.53 (95% predictive interval [PI], 1.11-2.12, 57.2%). The results were not confounded by BMI, study design, or class of SSI. The review found that cardiac surgery had the highest association between diabetes and SSI with an odds ratio of 2.03 (95% PI, 1.13-4.05, P = 0.001), although the increased risk was present for the majority of surgery types, including spinal and breast-related surgeries. Overall, diabetic patients were about 50 percent more likely to have an SSI over nondiabetic patients.

Examining incidence of SSI is important because of the impact they have on healthcare. They are the most frequent cause of hospital-acquired infection and frequently lead to rehospitalization (for which the CMS can penalize hospitals). The annual healthcare cost of SSI’s is more than $3 billion. Previous studies have identified that hyperglycemia and diabetes are risk factors for SSI, but this meta-analysis proves that the risk is present for a wide variety of surgical procedure types. Therefore, clinicians for surgical patients with diabetes should begin to take important precautions for prevention of SSI, such as potentially establishing and maintaining euglycemia before and after surgery and appropriate prophylaxis treatment. Further research is necessary to establish the relationship between level of glycemic control and risk of SSI following surgery in diabetes patients. In addition, more studies are needed to distinguish what differences in risk exist based on the patient’s type of diabetes.

Practice Pearls:

  • Diabetes in general is a risk factor for surgical site infection (SSI) post-surgery.
  • This meta-analysis reveals that the risk appears to be highest for cardiovascular surgery patients with diabetes.
  • Appropriate infection prophylaxis is extremely important for diabetic surgical patients in order to prevent these potentially costly and devastating infections.

Infection Control & Hospital Epidemiology, Available Martin ET, Kaye KS, Knott C, et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis on CJO 2015 doi:10.1017/ice.2015.249