Infections at point of surgery account for 14-17% of all hospital infections in patients and ranks third in causes for all post surgical infection. According to a report in the September issue of Archives of Surgery, a JAMA journal, increased blood sugar levels after surgery are linked to procedures in the operating room.
Ashar Ata, M.B.B.S., M.P.H., and colleagues at Albany Medical College, Albany state:
Studies have shown that these infections prolong the hospital length of stay after surgery, increase rehospitalization rates and dramatically increase the use of emergency services and health care costs.
Post surgery glucose levels were reviewed in 1,561 patients. Of these, vascular surgery took place in 559 (36%) persons, 226 (14%) had colon related surgery and 776 (50%) were a part of general surgery procedure. Almost seven and a half percent of the patients developed surgical site infections. Vascular patients at 10%, colorectal at 14% and 4% of the total having general surgeries.
Making adjustments for age, emergency status, physical status as classified by the American Society of Anesthesiologists, time in surgery, diabetes, it was concluded that almost all of these factors were not significant predictors of infections. A further analysis of colorectal surgery patients found that a postoperative serum glucose level higher than 140 milligrams per deciliter was a sign of surgical site infection, and in vascular patients, time of operation and existing diabetic conditions influenced signs of surgical site infection, although not associated with hyperglycemia.
Why are these infections dangerous? Hyperglycemia may impair the immune system, and insulin may have anti-inflammatory and other anti-infective activities. Much further investigation is necessary, as is the case in most scientific endeavors.
The authors conclude:
We found postoperative hyperglycemia to be the most important risk factor for surgical site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110 milligrams per deciliter were associated with increasingly higher rates of post-surgical infection. If hyperglycemia is confirmed in future prospective studies with better postoperative glucose data to be an independent risk factor for postsurgical infection in general surgery patients, this would give surgeons a modifiable variable to reduce the incidence of postoperative infection.
Written by: Sy Kraft, B.A. – Journalism – California State University, Northridge (CSUN)