Postoperative High Blood Sugar Appears to

Be Associated With Surgical Site Infection

ScienceDaily (Sep. 20, 2010)

Surgical site infection accounts for 14 percent to 17 percent of hospital-acquired infections, making it
the third most common type of infection acquired at health-care facilities and the most common among patients
having surgery, according to background information in the article. "Studies have shown that these infections
prolong the hospital length of stay after surgery, increase rehospitalization rates and dramatically increase the
use of emergency services and health care costs," the authors write.

Ashar Ata, M.B.B.S., M.P.H., and colleagues at Albany Medical College, Albany, N.Y., reviewed the
medical records of patients who had general or vascular surgery between Nov. 1, 2006, and April 30, 2009. A
total of 2,090 patients were randomly selected from a quality improvement database and then matched with
medical records to obtain information about postoperative glucose values. These values were available for
1,561 patients, including 559 who had vascular surgery, 226 who had colorectal surgery and 776 who had a
type of general surgery other than colorectal.

Overall, 7.42 percent of the patients developed surgical site infections, including 14.11 percent of those
who had colorectal surgery, 10.32 percent who had vascular surgery and 4.36 percent of those who had other
general surgery.

Among general surgery patients, factors associated with surgical site infection included age,
emergency status, physical status as classified by the American Society of Anesthesiologists, time in surgery,
diabetes and high postoperative blood glucose (hyperglycemia). However, after adjusting for postoperative
blood glucose level, all other factors were not significant predictors of infection. A subanalysis of colorectal
surgery patients found that a postoperative serum glucose level higher than 140 milligrams per deciliter was
the only significant predictor of surgical site infection.

Among vascular surgery patients, operative time and diabetes were the only significant predictors of
surgical site infection, which was not associated with postoperative hyperglycemia.

Hyperglycemia may impair the immune system, and insulin may have anti-inflammatory and other anti-
infective activities. However, it is possible that the accumulation of other risk factors for surgical site infection
cause hyperglycemia rather than vice versa; hence, further study is needed, the authors note.

"In conclusion, we found postoperative hyperglycemia to be the most important risk factor for surgical
site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110
milligrams per deciliter were associated with increasingly higher rates of post-surgical infection," they continue.
"If hyperglycemia is confirmed in future prospective studies with better postoperative glucose data to be an
independent risk factor for postsurgical infection in general surgery patients, this would give surgeons a
modifiable variable to reduce the incidence of postoperative infection."

SOURCE: JAMA and Archives Journals (2010, September 20). Postoperative high blood sugar appears to be associated with
surgical site infection.ScienceDaily. Retrieved September 23, 2010, from
http://www.sciencedaily.com/releases/2010/09/100920172634.htm

Summary:
 High blood glucose levels after surgery may be an important risk factor for infection at the
surgical site in patients having general surgery, according to a report in the September issue
of Archives of Surgery, one of the JAMA/Archives journals.
According to the studies, surgical site infection accounts for 14 percent to 17 percent of
hospital-acquired infections, making it the third most common type of infection acquired at health-care
facilities and the most common among patients having surgery. A study that was conducted by a
group of researchers and the results showed that hyperglycemia may impair the immune system, and
insulin may have anti-inflammatory and other anti-infective activities. However, it is possible that the
accumulation of other risk factors for surgical site infection cause hyperglycemia rather than vice
versa; hence, further study is needed, as what the researchers suggested. The researchers then
concluded that postoperative hyperglycemia to be the most important risk factor for surgical site
infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110
milligrams per deciliter were related with increasingly higher rates of post-surgical infection. They
continued that if hyperglycemia is confirmed in future prospective studies with better postoperative
glucose data to be an independent risk factor for postsurgical infection in general surgery patients,
this would give surgeons a modifiable variable to reduce the incidence of postoperative infection.
It was noted that a prospective study needs to be done, one that looks at current patients and,
specifically, at their blood sugar and risk for infection that would then lead to a more accurate result of
the problem.

Reaction:

There are a lot of factors that may cause infection in the surgical site but one of the classic
causes are high blood sugar level. Often people are too careless of the foods that they take in, such
as donuts, pizzas, pastries and a lot more. Blood sugar or glucose levels rise when the body is
unable to process the amount of glucose consumed. There are several reasons this may occur. In
those with diabetes, the body may not produce enough insulin to adequately process glucose or the
body may process glucose inefficiently. The patient may require medication and alter her lifestyle to
maintain adequate control. The article that I have read can really help me in my current studies, and it
can also help me teach my clients who will be undergoing surgeries with high blood sugar level. With
the knowledge I have learned with this article, I could integrate it with my plan of care and help my
patient recover faster or avoid any possible infections that he/she may encounter. A lot of people are
mostly unaware of this dreadful fact, I am happy to say that I could be their key to knowing and
avoiding the consequences of it.