Perioperative Hyperglycemia Linked to Postoperative Infection Risk

Independent of diabetes status, perioperative hyperglycemia is associated with an increased risk of postoperative infection, according to a new report.

Dr. Selwyn O. Rogers stated that,  “The completed study used a robust, risk-adjusted, validated outcomes-based database to demonstrate an association between perioperative glucose levels and postoperative infectious complications.”  “However, despite the strength of the association, this does not prove causation.”

Dr. Rogers from Brigham and Women’s Hospital, Boston, Massachusetts, and colleagues used data from the American College of Surgeons National Surgical Quality Improvement Program database to evaluate the risk of postoperative infection in patients undergoing major general and vascular surgery in relation to perioperative hyperglycemia.

In bivariate analysis, significant predictors of postoperative infection were preoperative and postoperative glucose, age, diabetes, American Society of Anesthesia Classification (ASAC), operation length and blood transfusions. On multivariate analysis, only postoperative glucose, ASAC and emergency status remained significant predictors.

Each 40 mg/dL increase above normal in postoperative glucose level was associated with a 30% increased risk of postoperative infection, the authors report.

Postoperative glucose levels were significantly higher for patients who developed pneumonia or surgical site infections than for patients who did not, the report indicates.

Elevated postoperative glucose was also associated with an increase in the length of hospital stay, the researchers note.
“Glucose control perioperatively may be useful for patient outcomes, but there are possible serious risks to do that — like overshooting and making the patient severely hypoglycemic,” Dr. Rogers said. “Further study in the postoperative setting on non-ICU surgical patients is needed to make this case more strongly.”

Ann Surg 2008;248:585-591.

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FACT: 

Heart Problems Worse For Diabetic Women, 34% More Likely To Die: Women younger than 65 with diabetes tend to have worse heart problems than diabetic men of the same age, leading to higher death rates following a heart attack, the results of a Swedish study indicate.

“The female advantage with fewer cardiovascular events than in men at younger ages is attenuated once a woman has the diagnosis of diabetes,” Dr. Anna Norhammar and associates write in the journal Heart. In fact, they add, “the risk is increased about twofold in men and up to four times in women.” 
See This Weeks’ Item #7

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