High Blood Sugar Associated with Postoperative Infection

Elevated blood glucose levels can be a predictor of infection after surgical intervention.

Surgical site infection accounts for 14% - 17% of hospital-acquired infections, making it the third most common type of infection acquired at healthcare facilities and the most common among patients having surgery.

In a review of 1,561 patients at Albany Medical College, (Albany, NY, USA), blood glucose values were available for 559 who had vascular surgery, 226 who had colorectal surgery and 776 who had a type of general surgery other than colorectal. Overall, 7.4% of the patients developed surgical site infections, including 14.1% of those who had colorectal surgery, 10.3% who had vascular surgery, and 4.4% of those who had other general surgery.

The most important risk factor for surgical site infection was postoperative hyperglycemia in general and colorectal cancer surgery patients. Those with serum glucose levels higher than 110 mg/dL were associated with increasingly higher rates of postsurgical infection. A subanalysis of colorectal surgery patients found that a postoperative serum glucose level higher than 140 mg/dL was the only significant predictor of surgical site infection. Among vascular surgery patients, operative time and diabetes were the only significant predictors of surgical site infection, which was not associated with postoperative hyperglycemia. The results of the study were published in the September 2010, issue of Archives of Surgery.

The authors noted, "If hyperglycemia is confirmed in future prospective studies with better postoperative glucose data to be an independent risk factor for post surgical infection in general surgery patients, this would give surgeons a modifiable variable to reduce the incidence of postoperative infection. Hyperglycemia may impair the immune system, and insulin may have anti-inflammatory and other anti-infective activities. However, it is possible that the accumulation of other risk factors for surgical site infection causes hyperglycemia rather than vice versa; hence, further study is needed."

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Albany Medical College