Post-operative Glycaemic Control Using an Insulin Infusion is Associated with Reduced Surgical Site Infections in Colore
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ORIGINAL SCIENTIFIC REPORT
Post-operative Glycaemic Control Using an Insulin Infusion is Associated with Reduced Surgical Site Infections in Colorectal Surgery Anthony J. Shakeshaft1 • Katherine Scanlon1 • Guy D. Eslick1 • Alisha Azmir1 Michael R. Cox1
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Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The incidence of surgical site infection (SSI) in colorectal surgery (CRS) is higher than other forms of general surgery. Post-operative hyperglycaemia causes increased SSI in CRS. Post-operative hyperglycaemia control in cardiac surgery reduces SSI. The aim was to evaluate using a cohort comparison the effect of post-operative glycaemic control using an insulin infusion on SSI in CRS. Methods Collection of data for the ACS-NSQIP was commenced in 2015. The CRS unit added post-operative glycaemic control to the SSI bundle in late 2016. The intervention was an insulin infusion to titrate blood glucose between 135 and 180 mg/Dl (7.5 and 10 mmol/l). The effect of glycaemic control on SSI was assessed comparing ACS-NSQIP raw data prior and after the intervention was commenced. Results The NSQIP data from July 2015 to June 2016 revealed the incidence of SSI were 25%. From January 2017 to December 2017, there was a significant reduction in SSI to 6.1% (OR = 517 Cl = 1.92–16.08, p \ 0.001). The incidence of organ/space SSI fell significantly from 13% to 1.0% (OR = 11.35, Cl = 1.62–488.7, p \ 0.001). There was non-significant reduction in superficial SSI from 11 to 4.0% (OR = 2.93, Cl = 0.68–13.03, p = 0.06). There was no significant difference in other factors associated with SSI in CRS. Conclusion Post-operative glycaemic control in CRS reduces the rate of SSI. Post-operative glycaemic control should be included in SSI bundles for CRS and may be of benefit in other surgical specialties.
Introduction Surgical site infections (SSI) are frequent in colorectal surgery (CRS) [1, 2] with a higher incidence than other forms of general surgery [3, 4]. SSI is associated with increased length of stay (LOS), readmission rates, re-operation rates, costs [5–7] and increased impairment of physical and mental well-being [8]. Factors associated with increased risk of SSI in CRS are: emergency CRS [9], obesity [2, 5, 9, 10], advanced age & Michael R. Cox [email protected] 1
Department of Surgery, Nepean Hospital, P. O. Box 63, Penrith, NSW 2751, Australia
[10], male gender [1], rectal surgery [4, 5, 9, 11, 12], postoperative hyperglycaemia (diabetics and non-diabetics) [5, 11–16], operative duration [1, 5, 9, 10], high American Society of Anaesthetists (ASA) score [10], transfusion [1] and open surgery [9]. Other than post-operative hyperglycaemia, none can be easily modified. Glycaemic control using an insulin infusion following cardiac surgery and other surgeries reduces SSI [11, 15, 17–20]. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) is a validated program providing risk-adjusted, operative outcomes data using standardised, prospective, high-quality clinical data [21
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