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Glycemic Control and Infections in Patients with Diabetes Undergoing Noncardiac Surgery

King, Joseph T. Jr., MD, MSCE*,†; Goulet, Joseph L. PhD, MS‡,§; Perkal, Melissa F. MD, FACS¶,**; Rosenthal, Ronnie A. MS, MD, FACS¶,**

Annals of Surgery:
doi: 10.1097/SLA.0b013e3181f9bb3a
Original Study
Abstract

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 (HbA1c) 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, HbA1c, 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.

In Brief

In a nationwide sample of 55,408 diabetic patients undergoing a wide variety of noncardiac surgical procedures, glucose control in the first 24 hours after surgery was poor, and mean glucose concentrations of 150 mg/dL and higher during this time period were associated with increased rates of postoperative infectious complications.

Author Information

*Section of Neurosurgery, VA Connecticut Healthcare System, West Haven, Connecticut

Department of Neurosurgery, Yale University, New Haven, Connecticut

Section of General Medicine, VA Connecticut Healthcare System, West Haven, Connecticut

§Department of Internal Medicine, Yale University, New Haven, Connecticut

Surgical Service, VA Connecticut Healthcare System, West Haven, Connecticut

**Department of Surgery, Yale University, New Haven, Connecticut.

Reprints: Joseph T. King, Jr., MD, MSCE, Surgery/112, VA Connecticut Healthcare System, West Haven, CT 06516. E-mail: joseph.kingjr@va.gov.

This research was supported by a grant from the Clinical Epidemiology Research Center, VA Connecticut Healthcare System (Primary Investigator, Ronnie A. Rosenthal, MS, MD, FACS).

Dr. Joseph T. King, Jr., had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The funding organization, the Clinical Epidemiology and Research Center, VA Connecticut Healthcare System played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Drs. Joseph T. King, Jr., and Joseph L. Goulet preformed the statistical analysis for this study. The VA National Surgical Quality Improvement Program reviewed and approved the manuscript before submission for publication.

This manuscript does not reflect the views of the Department of Veterans Affairs or the US Government.

© 2011 Lippincott Williams & Wilkins, Inc.