A study of surgical site infections associated with perioperative hyperglycemia in patients undergoing major emergency surgical procedures

Abstract

Objectives: To study the frequency of surgical site infection (SSI) associated with peri-operative hyperglycemia with respect to superficial, intermediate and deep infections, and to study the correlation of SSI between preoperative, intra-operative and postoperative hyperglycemia. Methods: This is a prospective study carried out from November 2017 to May 2019 on patients undergoing major emergency surgical procedures at Victoria Hospital, Bangalore Medical College and Research institute. After obtaining institutional ethics committee clearance and written informed consents, patients>18yrs of age undergoing major emergency surgical procedures fulfilling the inclusion/exclusion criteria will be enrolled in the study are subjected to serial hourly measurements of Capillary random blood sugars using hand held glucometer in the pre-operative, intra-operative and post-operative period. The total sample size was 232 patients calculated according to statistical formula. Results: Our study is indicative of a significant association of surgical site infections with peri-operative hyperglycemia, with the highest correlation with postoperative hyperglycemia. Although >90% of postoperative hyperglycemia was associated with uncontrolled diabetes, it can be seen that ~20-30% of subjects with pre- and intra-operative hyperglycemia were actually non-diabetics and may suggest a contributory role of stress-induced hyperglycemia in development of SSIs. Interpretation and Conclusion: Very few studies have shown the relation between preoperative, intra-operative and postoperative plasma sugars and SSIs. Hence strict control of sugars more so in the postoperative period will decrease the incidence of SSIs and hence the morbidity, cost and hospital stay associated with it.