Abstract
Aim: To evaluate the safety and effectiveness of a pilot program to control perioperative blood glucose in patients with diabetes. Methods: A pre-post intervention study was conducted in a 280-bed hospital in Spain. In the year 2008 we implemented perioperative insulin protocols aimed at blood glucose values from 80 to 180 mg/dL. Surgical patients with diabetes admitted on year 2009 (intervention group) were compared with a control group of patients with diabetes admitted for surgery on year 2007, matched 1:1 by traditional wound class. Results: We analyzed 96 patients. Implemented protocols were followed in 48% of patients intra-operatively and 75% of patients postoperatively. Patients in the intervention group had reductions in blood glucose at surgery 150 +/- 61 mg/dL vs. 172 +/- 53 mg/dL; p = 0.05), greater proportion of target glucose values throughout hospitalization (67% vs. 55%; p = 0.07), and reductions in the incidence of nosocomial infections after controlling for confounders (Odds Ratio: 0.20; 95% Confidence intervals: 0.06 - 0.72; p = 0.014) when they were compared with the control group: The incidence of hypoglycemia was similar between two groups (0.12% vs. 0.10%, p = 0.867), respectively. Conclusion: Although our protocol needs improvements to increase implementation it was useful to control blood glucose safely and for reducing nosocomial infections.
Highlights
The association between diabetes mellitus and greater risk of suffering from surgical site infections has been recognized for many years [1,2,3]
In the present study we evaluated the impact of a glycemic control protocol aimed at achieving blood glucose levels between 80 - 180 mg/dL on the perioperative period in patients undergoing abdominal and orthopedic surgery
From our institutional database registry we selected for inclusion from January through December 2007 an eligible patient with type 2 diabetes matched by wound class with those included in the post-intervention group
Summary
The association between diabetes mellitus and greater risk of suffering from surgical site infections has been recognized for many years [1,2,3]. Improving glycemic control in the preoperative period can reduce wound complications and nosocomial infections in patients with coronary artery by-pass graft [5,6]. The Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee recommends that preoperative blood glucose should be held to less than 200 mg/dL [7]. The recently published standards for diabetes care in hospitalized patients admitted to general medicine or surgical wards recommended maintaining blood glucose values below 180 mg/dL if they can be achieved safely [8]. Most experience of controlling diabetes in the operative period has been reported for patients undergoing cardiac surgery. There is insufficient evidence that strict blood glucose control prevents surgical site infections in patients undergoing abdominal or orthopedic surgery; the relative risk of infection compared to the risk of hypoglycemia has not been established
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