TITLE:
Clinically Relevant Assessment of the Variability of Glycemic Response and Its Affect on Surgical Site Infection Rates?
AUTHORS:
Ali Mahmood, Khaled I. El-Badawi, Theodor Asgeirsson, Vinay Gajula, Anthony J. Senagore
KEYWORDS:
Perioperative Glycemic; Glycemic Response Affect; Glucose Levels
JOURNAL NAME:
Surgical Science,
Vol.5 No.3,
March
14,
2014
ABSTRACT:
Purpose: Despite growing interest in perioperative glycemic control, little data existdefiningthe optimal value(s) to use to define appropriate glycemic management and the impact on the incidence of surgical site infection (SSI).The aim of this studywas to assess variation in glycemic response and risk of SSI and hospital stay as defined by themaximum, minimum, and area under the curve forperioperative glucose in patients undergoingcolectomy. We specifically used standard of care obtained glucose levels to reflect limitations of observations typically used to assess quality of care. Methods: All patients undergoing colectomy from 7/2007to6/2008 were assessed for themaximum and minimum levels of standard of care glucose levels, as well as area under the curve (AUC) forelevated glucoseperioperatively. These were assessed for patients with and without SSI(SSI vs nSSI). Results: 183 consecutive patients were evaluated (22 diabetics). The incidence of SSI forthe entirepopulation was 17/183 (9.3%) without significant difference between thegroups with respect to meanblood glucose level (SSI-136; nSSI-136). However, the SSIgroup had a higher maximum glucose level(SSI-194; nSSI 162; p110mg/dl (SSI-59%; nSSI-62%) or glucose >150mg/dl (SSI 6%; nSSI 18%). Conclusions: The data demonstrate that patients with SSI have wider fluctuations inglycemic responsecompared to non-SSI when standard of care serum glucose levelswasreviewed. Therefore, quality program monitoring of glucose impact on SSI should focus on both maximum and minimum levels during the perioperative period to better define process improvement in colectomy patients.