From the Guidelines
Hyperglycemia is strongly associated with an increased risk of surgical site infections (SSIs), and maintaining tight glycemic control is crucial to reduce this risk. To minimize the risk of SSIs, the following strategies should be implemented:
- Maintain blood glucose levels between 140-180 mg/dL for most surgical patients, as this range has been shown to reduce morbidity and mortality in diabetic patients undergoing surgery 1.
- Implement perioperative insulin protocols, using intravenous insulin infusions for major surgeries or in patients with poorly controlled diabetes, starting with 1-2 units/hour and adjusting based on hourly glucose checks 1.
- Continue glucose monitoring for at least 24-48 hours post-surgery, or longer for major procedures, to ensure that blood glucose levels remain within the target range.
- Optimize nutrition and wound care to promote healing and reduce infection risk, as hyperglycemia can impair immune function and decrease collagen formation 1.
- Consider prophylactic antibiotics as per standard surgical guidelines, as the risk of SSI is increased in patients with hyperglycemia.
The relationship between hyperglycemia and SSI is well-established, with studies demonstrating that tight glycemic control can reduce the risk of SSI and improve overall surgical outcomes 1. Hyperglycemia impairs immune function, decreases collagen formation, and promotes bacterial growth, all of which contribute to increased SSI risk. By maintaining tight glycemic control and implementing perioperative insulin protocols, healthcare providers can mitigate these effects and reduce the risk of SSI.
From the Research
Relationship Between Surgical Site Infections and Hyperglycemia
The relationship between surgical site infections (SSIs) and hyperglycemia is well-established in the literature. Hyperglycemia, or high blood sugar, has been shown to increase the risk of SSIs in both diabetic and non-diabetic patients undergoing surgery 2, 3, 4.
Key Findings
- A meta-analysis of 29 randomized controlled trials found that intensive insulin regimens decreased the risk of SSIs in patients with diabetes, as well as in cardiac and abdominal surgical procedures 2.
- A study of 1555 patients undergoing gastroenterological surgery found a dose-response relationship between the level of hyperglycemia and the odds of SSI, with a target blood glucose level of ≤150 mg/dL recommended for patients without diabetes 3.
- A retrospective review of 762 adult non-cardiac surgical patients with diabetes found that monitoring blood glucose values during the perioperative period may allow for early treatment and prevent complications related to poor glycemic control 5.
- A study of 1612 patients undergoing gastrointestinal surgery found that improvement in hyperglycemia, irrespective of insulin use, prevented SSI in non-diabetic patients 4.
Glycemic Control Strategies
- Intensive glycemic control is recommended to prevent SSIs, with a target blood glucose level of <180 mg/dL 2, 6.
- Screening, monitoring, and treatment of hyperglycemia are essential in the perioperative period, including the use of oral hypoglycemics and insulin therapy 6.
- Partnerships with surgery and endocrinology teams can aid in optimal postoperative management and discharge planning 6.