Cited by 379Hyperglycemia and glycemic control in critically ill and hospitalized patientsSurgical site infection preventionEnhanced Recovery After Surgery

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Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients

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Ata, Ashar·2010·Archives of Surgery

DOI 10.1001/archsurg.2010.179

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Abstract

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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Background
Hyperglycemia and Acute Kidney Injury During the Perioperative Period
Mendez, C. E., Mesropian, P. J. D., Mathew, R. O., & Slawski, B. A. (2016) · Current Diabetes Reports · doi:10.1007/s11892-015-0701-7 · Cited by 56
Persistent Postoperative Hyperglycemia as a Risk Factor for Operative Treatment of Deep Wound Infection After Spine Surgery
Pennington, Z. A., Lubelski, D., Westbroek, E. M., Ahmed, A. K., Passias, P. G., & Sciubba, D. M. (2019) · Neurosurgery · doi:10.1093/neuros/nyz405 · Cited by 52
The Role of Pre-Operative and Post-Operative Glucose Control in Surgical-Site Infections and Mortality
Jeon, C. Y., Furuya, E. Y., Berman, M. F., & Larson, E. (2012) · PLoS ONE · doi:10.1371/journal.pone.0045616 · Cited by 52
“Furthermore, most studies have not investigated the role of variations in glucose levels, which has been found to predict SSIs, along with absolute glucose levels [20].”
BackgroundResultInfluential
Combined utility of white blood cell count and blood glucose for predicting in-hospital outcomes in acute ischemic stroke
You, S., Ou, Z., Zhang, W., Zheng, D., Zhong, C., Dong, X., Qiu, C., Lu, T.-S., Cao, Y., & Liu, C. (2019) · Journal of Neuroinflammation · doi:10.1186/s12974-019-1422-7 · Cited by 51
Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database
Mohan, S., Kaoutzanis, C., Welch, K. B., Vandewarker, J. F., Winter, S. M., Krapohl, G. L., Lampman, R. M., Franz, M., & Cleary, R. K. (2015) · International Journal of Colorectal Disease · doi:10.1007/s00384-015-2322-7 · Cited by 51
Perioperative Management of Patients with Diabetes and Hyperglycemia Undergoing Elective Surgery
Thompson, B., Stearns, J. D., Apsey, H. A., Schlinkert, R. T., & Cook, C. B. (2015) · Current Diabetes Reports · doi:10.1007/s11892-015-0700-8 · Cited by 51
Evidence-Based Medicine: Wound Management
Jones, C. M., Rothermel, A. T., & Mackay, D. R. (2017) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000003486 · Cited by 64
Anesthesia for the elderly outpatient
Aurini, L., & White, P. F. (2014) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000000135 · Cited by 53
Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience
Silvestri, M., Dobrinja, C., Scomersi, S., Giudici, F., Turoldo, A., Princic, E., Luzzati, R., de Manzini, N., & Bortul, M. (2017) · Surgery Today · doi:10.1007/s00595-017-1590-y · Cited by 46
The impact of obesity on outcomes for patients undergoing mastectomy using the ACS-NSQIP data set
Garland‐Kledzik, M., Hsu, F., Clark, C. J., Chiba, A., & Howard-McNatt, M. M. (2018) · Breast Cancer Research and Treatment · doi:10.1007/s10549-017-4651-4 · Cited by 46
A Scoping Review of GLP-1 Receptor Agonists: Are They Associated with Increased Gastric Contents, Regurgitation, and Aspiration Events?
Chang, M. G., Ripoll, J. G., Lopez, E., Krishnan, K., & Bittner, E. A. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216336 · Cited by 43
Determinants of Surgical Site Infections Following Pancreatoduodenectomy
Barreto, S. G., Kumar, M., Sharma, S., & Chaudhary, A. (2015) · World Journal of Surgery · doi:10.1007/s00268-015-3115-4 · Cited by 43
“This is in contrast to other studies which demonstrate a higher rate of SSIs in diabetics possibly related to problems with their glycaemic control in the perioperative period [28].”
Result
Surgical Site Infections in Gastroenterological Surgery
Matsuda, A., Yamada, T., Ohta, R., Sonoda, H., Shinji, S., Iwai, T., Takeda, K., Yonaga, K., Ueda, K., Kuriyama, S., et al. (2022) · Journal of Nippon Medical School · doi:10.1272/jnms.jnms.2023_90-102 · Cited by 41
Risk of stroke-associated pneumonia during hospitalization: predictive ability of combined A2DS2 score and hyperglycemia
Li, Y., Zhang, Y., Ma, L., Niu, X., & Chang, J. (2019) · BMC Neurology · doi:10.1186/s12883-019-1497-x · Cited by 41
The effects of medical staff turning movements on airflow distribution and particle concentration in an operating room
Kamar, H. M., Wong, K. Y., & Kamsah, N. (2020) · Journal of Building Performance Simulation · doi:10.1080/19401493.2020.1812722 · Cited by 41
Strict glycemic control to prevent surgical site infections in gastroenterological surgery
Takesue, Y., & Tsuchida, T. (2017) · Annals of Gastroenterological Surgery · doi:10.1002/ags3.12006 · Cited by 43
“A dose–response relationship between BG level and SSI rate was reported in general surgery patients.(14) Bivariate analysis revealed that compared with patients with a first postoperative BG ≤110 mg/dL, the likelihood of acquiring an SSI increased progressively for patients with higher BG (OR 3.”
BackgroundResultInfluential
Perioperative intensive insulin therapy using an artificial endocrine pancreas with closed-loop glycemic control system: the effects of no hypoglycemia
Hanazaki, K., Kitagawa, H., Yatabe, T., Munekage, M., Dabanaka, K., Takezaki, Y., Tsukamoto, Y., Asano, T., Kinoshita, Y., & Namikawa, T. (2014) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2013.07.048 · Cited by 40
Perineural Ultrasound-Guided Catheter Bacterial Colonization
Aveline, C., Hétêt, H. L., Roux, A., Vautier, P., Gautier, J. F., Cognet, F., Auger, P., & Bonnet, F. J. (2011) · Regional Anesthesia & Pain Medicine · doi:10.1097/aap.0b013e31822e665a · Cited by 39
“Diabetes is a risk factor for postoperative surgical site infection in general surgery, and impaired glucose control is associated with infection.(18) Although never reported as a statistical relationship in prospective studies, the increased risk of colonization and, consequently, infection in diabetic patients has b…”
Background
Diabetes
Bomberg, H., Kubulus, C., List, F., Albert, N., Schmitt, K., Gräber, S., Kessler, P., Steinfeldt, T., Standl, T. G., Gottschalk, A., et al. (2014) · Regional Anesthesia & Pain Medicine · doi:10.1097/aap.0000000000000196 · Cited by 39
“Furthermore, diabetes seems to be also associated with an increased risk for surgical site infections in general surgery.(26) Diabetes is a well-known risk factor for skin and soft tissue infections.”
Background
Quantification of the Effect of Diabetes Mellitus on Ventral Hernia Repair: Results from Two National Registries
Huntington, C. R., Gamble, J., Blair, L. J., Cox, T. C., Prasad, T., Lincourt, A. E., Augenstein, V. A., & Heniford, B. T. (2016) · The American Surgeon · doi:10.1177/000313481608200822 · Cited by 39
Glycemic Control and Prevention of Surgical Site Infection
Kao, L. S., & Phatak, U. R. (2013) · Surgical Infections · doi:10.1089/sur.2013.008 · Cited by 41
“A single-center study showed that among general surgery patients, SSI rates increased with each stratum of post-operative glucose concentrations (Table 2 [19]).”
Prevention of Periprosthetic Joint Infection: Examining the Recent Guidelines
Shohat, N., & Parvizi, J. (2017) · The Journal of Arthroplasty · doi:10.1016/j.arth.2017.02.072 · Cited by 38
Perioperative hyperglycemia: an unmet need within a surgical site infection bundle
Gachabayov, M., Senagore, A. J., Abbas, S. K., Yelika, S. B., You, J. K., & Bergamaschi, R. C. (2018) · Techniques in Coloproctology · doi:10.1007/s10151-018-1769-2 · Cited by 40
The Use of a Pre-operative Carbohydrate Drink in Patients with Diabetes Mellitus: A Prospective, Non-inferiority, Cohort Study
Laffin, M. R., Li, S., Brisebois, R., Senior, P., & Wang, H. (2018) · World Journal of Surgery · doi:10.1007/s00268-017-4413-9 · Cited by 35
Pressurized Pulse Irrigation with Saline Reduces Surgical‐site Infections following Major Hepatobiliary and Pancreatic Surgery: Randomized Controlled Trial
Nikfarjam, M., Weinberg, L., Fink, M. A., Muralidharan, V., Starkey, G., Jones, R. M., Staveley-O’Carroll, K. F., & Christophi, C. (2013) · World Journal of Surgery · doi:10.1007/s00268-013-2309-x · Cited by 36
“We also controlled for distribution of patients with diabetes and maintained tight perioperative glycemic control to minimize its impact on SSI [24].”
Background
Readmission rates after lower extremity bypass vary significantly by surgical indication
Jones, C. E., Richman, J., Chu, D. I., Gullick, A. A., Pearce, B. J., & Morris, M. S. (2016) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2016.03.422 · Cited by 36
Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures
Justinger, C., Slotta, J. E., & Schilling, M. K. (2011) · Surgery · doi:10.1016/j.surg.2011.08.004 · Cited by 36
Postoperative hyperglycemia in nondiabetic patients after gastric surgery for cancer: perioperative outcomes
Fiorillo, C., Rosa, F., Quero, G., Menghi, R., Doglietto, G. B., & Alfieri, S. (2016) · Gastric Cancer · doi:10.1007/s10120-016-0621-5 · Cited by 35
Perioperative hyperglycaemia and incidence of post‐operative complications in patients undergoing total knee arthroplasty
Reátegui, D., Sánchez‐Etayo, G., Núñez, E., Tió, M., Popescu, D., Núñez, M., & Lozano, L. (2014) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-014-2907-7 · Cited by 35
Inpatient Continuous Glucose Monitoring and Glycemic Outcomes
Levitt, D. L., Silver, K. D., & Spanakis, E. K. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817698499 · Cited by 35
“1 million hospital days,(5) a significant proportion of which without goal glycemic control, with hyperglycemia detected in up to 38% of all patients associated with increased morbidity and mortality.(6-13) Moreover, hypoglycemia is detected in up to 30% of Type 2 Diabetes Mellitus (T2DM) patients treated with subcuta…”
Background
Postoperative sepsis
Fried, E., Weissman, C., & Sprung, C. L. (2011) · Current Opinion in Critical Care · doi:10.1097/mcc.0b013e328348bee2 · Cited by 35
Association between acute phase perioperative glucose parameters and postoperative outcomes in diabetic and non-diabetic patients undergoing non-cardiac surgery
Nair, B. G., Neradilek, M. B., Newman, S.-F., & Horibe, M. (2018) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2018.10.024 · Cited by 34
Effects of a preoperative immune-modulating diet in patients with esophageal cancer: a prospective parallel group randomized study
Kitagawa, H., Namikawa, T., Yatabe, T., Munekage, M., Yamasaki, F., Kobayashi, M., & Hanazaki, K. (2017) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-016-1538-5 · Cited by 33
Current topics in glycemic control by wearable artificial pancreas or bedside artificial pancreas with closed-loop system
Hanazaki, K., Munekage, M., Kitagawa, H., Yatabe, T., Munekage, E., Shiga, M., Maeda, H., & Namikawa, T. (2016) · Journal of Artificial Organs · doi:10.1007/s10047-016-0904-y · Cited by 33
Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification
Coan, K. E., Schlinkert, A. B., Beck, B. R., Haakinson, D. J., Castro, J. C., Apsey, H. A., Schlinkert, R. T., & Cook, C. B. (2013) · Journal of Diabetes Science and Technology · doi:10.1177/193229681300700410 · Cited by 31
“None Oral Oral plus insulin Insulin 12 (10) 3 (3) 37 (31) 67 (56)”
Daily Inpatient Glycemic Survey (DINGS): A Process to Remotely Identify and Assist in the Management of Hospitalized Patients with Diabetes and Hyperglycemia
Mendez, C. E., Ata, A., Rourke, J. M., Stain, S. C., & Umpierrez, G. E. (2015) · Endocrine Practice · doi:10.4158/ep14577.or · Cited by 30
Self-citation
Clinical significance of perioperative hyperglycemia in bariatric surgery: evidence for better perioperative glucose management
Meister, K. M., Hufford, T. A., Tu, C., Khorgami, Z., Schauer, P. R., Brethauer, S. A., & Aminian, A. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.07.028 · Cited by 31
Colorectal surgical site infection reduction strategies
DeHaas, D. R., Aufderheide, S., Gano, J., Weigandt, J., Ries, J., & Faust, B. (2016) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2016.04.001 · Cited by 29
Implementation of a referral to discharge glycemic control initiative for reduction of surgical site infections in gynecologic oncology patients
Hopkins, L., Brown‐Broderick, J., Hearn, J., Malcolm, J., Chan, J. W. T., Hicks-Boucher, W., Sousa, F. D., WALKER, M. C., & Gagné, S. (2017) · Gynecologic Oncology · doi:10.1016/j.ygyno.2017.05.021 · Cited by 30
Reducing surgical site infection in arthroplasty of the lower limb
Johnson, R., Jameson, S. S., Sanders, R. D., Sargant, N., Müller, S., Meek, R. M. D., & Reed, M. R. (2013) · Bone and Joint Research · doi:10.1302/2046-3758.23.2000146 · Cited by 29
Admission Hyperglycemia Is a Risk Factor for Deep Surgical-Site Infection in Orthopaedic Trauma Patients
Anderson, B. M., Wise, B. T., Joshi, M., Castillo, R., O'Toole, R. V., & Richards, J. E. (2021) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0000000000002101 · Cited by 28
Laser in-situ keratomileusis in patients with diabetes mellitus: a review of the literature
Moshirfar, M., Simpson, R. G., Christiansen, S. M., & Edmonds (2012) · Clinical ophthalmology · doi:10.2147/opth.s36382 · Cited by 29
“The same study found a linear relationship between glucose level and infection risk; the higher the serum glucose at time of surgery, the greater the risk of infection.(46) It follows that diabetic patients with a history of tight glycemic control and hemoglobin A1c levels at or below target levels do not appear to be…”
Influential
Diabetes Mellitus
Sreedharan, R., & Abdelmalak, B. (2018) · Anesthesiology Clinics · doi:10.1016/j.anclin.2018.07.007 · Cited by 32

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)
DOI: 10.1001/archsurg.2010.179
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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Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients

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