Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients
Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients
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DOI：
10.1001/archsurg.2010.179
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发表时间：
2010-09-01
影响因子：
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通讯作者：
Stain, Steven C.
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文献类型：
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作者：
Ata, Ashar;Lee, Julia;Stain, Steven C.
假设：术后高血糖是术后手术部位感染 (SSI) 的独立危险因素。设计：回顾性病历审查。设置：学术三级转诊中心。患者：机构质量改进数据库中 2006 年 11 月 1 日至 2009 年 4 月 30 日期间总共 2090 名普外科和血管外科患者。主要结果指标：术后 SSI.结果：1561例患者（74.7.0%）获得术后血糖水平，其中803例（51.4%）在手术后12小时内获得。普外科患者中 SSI 的显着单变量预测因素包括年龄增长、急诊状态、美国麻醉医师协会身体状况等级 P3 至 P5、手术时间、输注红细胞超过 2 U、术前血糖水平高于 180 mg/dL（换算为毫摩尔每升，乘以 0.0555）、糖尿病和术后高血糖。在多变量调整中，年龄增加、紧急状态、美国麻醉医师协会 P3 至 P5 级、手术时间和糖尿病仍然是普外科患者 SSI 的重要预测因素。调整术后血糖水平后，所有这些变量不再是 SSI 的显着预测因子；只有术后血糖水平的增量仍然显着。亚组分析显示，对于结直肠手术患者，血清葡萄糖水平高于 140 mg/dL 是 SSI 的唯一显着预测因素（比值比，3.2；95% 置信区间 [CI]，1.4-7.2）。血管手术患者发生 SSI 的可能性是普通手术患者的 1.8 倍（95% Cl，1.3-2.5 倍）。手术时间和糖尿病是血管手术患者SSI唯一显着的单变量预测因素，术后高血糖与SSI无关。结论：术后高血糖可能是SSI最重要的危险因素。术后早期积极控制血糖可降低 SSI 的发生率。
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. Sub-analysis 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% Cl, 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.