JAMA Logo Patients who underwent surgery may often face threats of developing surgical site infection. Due to these infections the length of hospital study can probably be extended further causing elevation in rehospitalization rates, increase in the use of emergency services and health care costs. According to a recent study, high blood glucose levels after surgery may be an important risk factor for infection at the surgical site in patients having general surgery.

At the time of the study, experts examined medical records of patients who had general or vascular surgery between November 1, 2006, and April 30, 2009. Then 2,090 patients were randomly selected from a quality improvement database. These patients were compared with medical records for gaining information about postoperative glucose values. 1,561 patients were provided with these values. Among these patients, while 559 had vascular surgery and 226 had colorectal surgery, 776 had a type of general surgery other than colorectal. In totality, it appeared that 7.42 percent of the patients developed surgical site infections, including 14.11 percent of those who had colorectal surgery, 10.32 percent who had vascular surgery and 4.36 percent of those who had other general surgery.

Investigators shared, “In conclusion, 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.”

In accordance to the American Society of Anesthesiologists, factors related with surgical site infection in general surgery patients comprise age, emergency status, physical status, time in surgery, diabetes and high postoperative blood glucose (hyperglycemia). But after adjusting for postoperative blood glucose level, the investigators were unable to ascertain them as significant predictors of infection. Through a subanalysis of colorectal surgery patients it was observed that postoperative serum glucose level higher than 140 milligrams per deciliter was the only critical predictor of surgical site infection.

Ashar Ata, M.B.B.S., M.P.H., and colleagues at Albany Medical College, Albany, N.Y., noted that in vascular surgery patients, operative time and diabetes were the only significant predictors of surgical site infection. These predictors were apparently not linked with postoperative hyperglycemia. It is known that hyperglycemia hampers the immune system and insulin has anti-inflammatory along with other anti-infective activities. Further investigations can be conducted to find out whether accumulation of other risk factors for surgical site infection causes hyperglycemia.

The study is published in the September issue of Archives of Surgery, one of the JAMA/Archives journals.