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Background: �Previous studies have shown an association between perioperative� hyperglycemia and surgical site infection among patients undergoing cardiac surgery.� Intensive insulin therapy in the postoperative period decreases the incidence of surgical site infection following cardiac surgery.� It is not known if hyperglycemia increases the risk of infection following non cardiac surgery.
Objective: � To determine if post operative hyperglycemia increases the risk of surgical site infection following non-cardiac surgery.
Methods: � The study was conducted at a 156 bed VA hospital.� Sixty six patients with surgical site infection following orthopedic, peripheral vascular or neurologic surgery were identified by routine surveillance by the infection control program during the period 12/2002 � 12/2008.� All cases met CDC criteria for surgical site infection.�� Cases were matched with non infected controls for type of procedure and year.� Data collected included demographics, presence of previously diagnosed diabetes, wound classification, duration of surgery, body mass index, and blood glucose measurements during the 48 hours post procedure.� �We defined hyperglycemia as blood glucose level > 200 mg/dl, a level found to correlate with an increased risk of surgical site infection in cardiac surgery.
Results: On univariate analysis age, non white race, hyperglycemia, repeat operation, obesity (BMI > 30), and diabetes were associated with surgical site infection.� On multivariate analysis, only hyperglycemia (OR 4.9; 95% CI 1.3 � 18.5) and repeat operation (OR 27; 95% CI 9.5 � 77) were independently associated with infection.�
Conclusions: �Post operative hyperglycemia is significantly associated with surgical site infection in orthopedic, vascular and neurologic surgery.� Future investigation to determine the effect of aggressive perioperative glucose control on the occurrence of surgical site infection in non-cardiac surgery is warranted.�