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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.