Clinically Relevant Assessment of the Variability of Glycemic Response and Its Affect on Surgical Site Infection Rates?

Abstract

Purpose: Despite growing interest in perioperative glycemic control, little data existdefining the 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 study was to assess variation in glycemic response and risk of SSI and hospital stay as defined by themaximum, minimum, and area under the curve for perioperative glucose in patients undergoing colectomy. 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 7/2007 to 6/2008 were assessed for the maximum and minimum levels of standard of care glucose levels, as well as area under the curve (AUC) for elevated glucose perioperatively. These were assessed for patients with and without SSI (SSI vs nSSI). Results: 183 consecutive patients were evaluated (22 diabetics). The incidence of SSI for the entire population was 17/183 (9.3%) without significant difference between the groups with respect to mean blood glucose level (SSI-136; nSSI-136). However, the SSI group had a higher maximum glucose level (SSI-194; nSSI 162; p < 0.05) and a lower minimum glucose level (SSI-100; nSSI 117; p < 0.05). Using AUCs for elevated glucose, there was no significant difference in the percentage of SSI patients with glucose > 110 mg/dl (SSI-59%; nSSI-62%) or glucose > 150 mg/dl (SSI 6%; nSSI 18%). Conclusions: The data demonstrate that patients with SSI have wider fluctuations inglycemic response compared to non-SSI when standard of care serum glucose levels wasreviewed. 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.