Postoperative hyperglycemia and surgical site infection in general surgery patients
Open accessAbstract
HYPOTHESIS: Postoperative hyperglycemia is an independent risk factor for postoperative surgical site infection (SSI). DESIGN: Retrospective medical record review. SETTING: Academic tertiary referral center. PATIENTS: A total of 2090 general and vascular surgery patients in an institutional quality improvement database between November 1, 2006, and April 30, 2009. MAIN OUTCOME MEASURE: Postoperative SSI. RESULTS: Postoperative glucose levels were available for 1561 patients (74.7.0%), of which 803 (51.4%) were obtained within 12 hours of surgery. The significant univariate predictors of SSI in general surgery patients were increasing age, emergency status, American Society of Anesthesiologists physical status classes P3 to P5, operative time, more than 2 U of red blood cells transfused, preoperative glucose level higher than 180 mg/dL (to convert to millimoles per liter, multiply by 0.0555), diabetes mellitus, and postoperative hyperglycemia. On multivariate adjustment, increasing age, emergency status, American Society of Anesthesiologists classes P3 to P5, operative time, and diabetes remained significant predictors of SSI for general surgery patients. After adjustment for postoperative glucose level, all these variables ceased to be significant predictors of SSI; only incremental postoperative glucose level remained significant. Subanalysis revealed that a serum glucose level higher than 140 mg/dL was the only significant predictor of SSI (odds ratio, 3.2; 95% confidence interval [CI], 1.4-7.2) for colorectal surgery patients. Vascular surgery patients were 1.8 times (95% CI, 1.3-2.5 times) more likely to develop SSI than were general surgery patients. Operative time and diabetes mellitus were the only significant univariate predictors of SSI among vascular surgery patients, and postoperative hyperglycemia was not associated with SSI. CONCLUSIONS: Postoperative hyperglycemia may be the most important risk factor for SSI. Aggressive early postoperative glycemic control should reduce the incidence of SSI.
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The glycemic threshold for an increase in complications is estimated to be somewhere between 100 and 180 mg/dL in most studies.
“The glycemic threshold for an increase in complications is estimated to be somewhere between 100 and 180 mg/dL (5.5 and 10 mmol/L) in most of these studies (135-138).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [137]
The COMMENT section reports a 140 mg/dL cutoff for increased surgical-site infection rates in this study, which falls within the claimed range. It does not establish that most studies find a threshold between 100 and 180 mg/dL; the same section describes prior studies as inconclusive and reports some associations above 200 mg/dL. (LLM, conf=0.84)
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- Authors
- Ata, A.
- Affiliations
- Albany Medical College (US)
- Corresponding author
- Ata, Ashar
- ORCID
- Ata, Ashar
- Venue
- Archives of Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2010-09-20
- Volume
- 145
- Issue
- 9
- Pages
- 858
- ISSN
- 0004-0010 (ISSN-L)
- OpenAlex
- W2088981885
- Cited by
- 379
- References
- 42
- Citations by year
- 2026: 24 · 2025: 19 · 2024: 27 · 2023: 15 · 2022: 25 · 2021: 19 · 2020: 28 · 2019: 22 · 2018: 22 · 2017: 28 · 2016: 29 · 2015: 22 · 2014: 27 · 2013: 28 · 2012: 21
- FWCI
- 17.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- postoperative hyperglycemia, surgical site infection, general surgery, vascular surgery, risk factors, glycemic control, diabetes mellitus, colorectal surgery, operative time, American Society of Anesthesiologists physical status, emergency surgery
- MeSH terms
- Adolescent, Adult, Age Factors, Anesthesia, Blood Transfusion, Diabetes Mellitus, Emergency Medical Services, Female, Humans, Hyperglycemia, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Factors, Surgical Procedures, Operative, Surgical Wound Infection, Vascular Surgical Procedures, Comorbidity, Databases, Factual, Young Adult
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