Hyperglycemia is Associated with Surgical Site Infections among General and Vascular Surgery Patients

Abstract

Surgical site infection (SSI) is a common cause of morbidity in general and vascular surgery patients. There is inconsistent evidence on the association of glycemic status with SSI, and its utility in predicting and mitigating SSI. General and vascular surgery patients at a public teaching hospital had the following markers of glycemic status prospectively collected: preoperative hemoglobin A1c (HbA1c) and capillary blood glucose (cBG, within six months before surgery), perioperative cBG (within 24 hours before surgery), and postoperative cBG (peak value up to 48 hours after surgery). Patient records were assessed for SSI within 30 days of surgery. Over a two-month period, 229 patients underwent surgery. The overall SSI rate was 9.6 per cent. Preoperative HbA1c >7 per cent and postoperative cBG ≥180 mL/dL occurred in 25.9 and 27.0 per cent of patients, respectively. Preoperative HbA1c >7 per cent was significantly associated with SSI [odds ratio (OR) 2.26, 80 per cent confidence interval (CI) 1.01–5.07], as was postoperative cBG ≥180 mg/dL (OR 2.12, 80 per cent CI 1.02–4.41). There was no significant correlation between preoperative or perioperative cBG and SSI. In conclusion, SSI and hyperglycemia were frequent among the study population, and positively associated. Glycemic status may be used for improved preoperative risk assessment, and as it is potentially mutable, to reduce SSI.