Key result
Mean 24-hour postoperative serum glucose ≥150 mg/dL was associated with higher infection rates (IRR 1.22 for 150-250 mg/dL; IRR 1.43 for >250 mg/dL) in diabetic noncardiac surgery patients.
Why the study?
Does poor postoperative glucose control (≥150 mg/dL) increase postoperative infections in diabetic patients undergoing noncardiac surgery?
Does poor postoperative glucose control (≥150 mg/dL) increase postoperative infections in diabetic patients undergoing noncardiac surgery?
In diabetic patients undergoing noncardiac surgery, mean serum glucose concentrations ≥150 mg/dL in the first 24 hours postoperatively are associated with increased rates of postoperative infections, whereas preoperative HbA1c and glucose are not.
Postoperative glucose monitoring merits attention in diabetic noncardiac surgery; leaves open whether tighter control reduces infections in trials.
OBJECTIVE: Examine the relationship between perioperative glucose control and postoperative infections in a nationwide sample of diabetic patients undergoing a wide variety of surgical procedures. SUMMARY OF BACKGROUND DATA: Perioperative glucose control has been linked to postoperative infections after selected surgical procedures. METHODS: Retrospective analysis of surgical outcomes data from 1999 to 2004 on 55,408 patients with diabetes undergoing a variety of noncardiac operations contained in the Veterans Heath Administration National Surgical Quality Improvement Program database, supplemented with the Veterans Heath Administration Decision Support Services hemoglobin A1c (HbA(₁c)) and serum glucose data. Multivariate Poisson regression model of postoperative infection including demographics, comorbidities, functional status, preoperative laboratories, surgical data, and glucose control (diabetes medications, serum glucose, HbA(₁c), mean serum glucose within 24 hours after surgery). RESULTS: The most common procedures were herniorrhaphy (10%), carotid endarterectomy (6.6%), and open colectomy (5.6%). Mean (SD) preoperative HbA1c concentration was 7.9% (2.3); 51% of patients had preoperative serum glucose concentrations more than 150 mg/dL; and 72% of patients had a mean 24 hour postoperative glucose concentration at least 150 mg/dL. The overall postoperative infection rate was 8.0%. Higher rates of postoperative infection were associated with mean 24 hour postoperative serum glucose concentrations of 150 to 250 mg/dL (incidence rate ratio 1.22, 95% confidence interval, 1.04-1.43; P = 0.01) and more than 250 mg/dL (incidence rate ratio: 1.43; 95% confidence interval, 1.19-1.71; P < 0.001). Preoperative HbA1c and glucose concentrations were not associated with increased infection rates. CONCLUSIONS: In a large nationwide sample of diabetic patients undergoing a variety of noncardiac surgical procedures, glucose control in the first 24 hours after surgery was poor, and mean serum glucose concentrations of 150 mg/dL and higher during this time period were associated with increased rates of postoperative infectious complications.
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King et al. (2010) studied this question. Mean 24-hour postoperative serum glucose ≥150 mg/dL was associated with higher infection rates (IRR 1.22 for 150-250 mg/dL; IRR 1.43 for >250 mg/dL) in diabetic noncardiac surgery patients.
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