Perioperative Hyperglycemia as a Risk Factor for Early Surgical-Site Infection in Stable Trauma Patients in Orthopedic Unit
Introduction: Perioperative hyperglycemia resulted from known diabetes mellitus, occult diabetes or stressed-induced hyperglycemia. It is associated with increasing risk of surgical-site infection (SSI). This research is to evaluate relationship between perioperative hyperglycemia and early SSI in stable trauma patients with orthopaedic injuries. Materials and method: We conducted an observational cohort study in Hospital Sultanah Nur Zahirah, Kuala Terengganu over 15 months. We included patients 18 years and older with operative orthopaedic injuries and excluded those with steroid use, multisystem injuries, critically ill or unstable and patients with perioperative infection. Demographics, medical comorbidities, body mass index, type of fracture, HbA1c level in diabetic patients and length of hospital stay were recorded. Fingerprick glucose values were obtained twice daily. Hyperglycemic index (HGI), an area under the glucose curve above the normal range divided by the length of stay, were calculated. Perioperative hyperglycemia was defined by HGI greater than 1.76. SSI was defined by gross purulence or positive intraoperative culture at reoperation within 30 days. The categorical data were analysed using chi square test while continuous data were analysed using T-test. Results: Total of 90 patients, 15-diabetic and 75 non-diabetic. 10 diabetic and 1 non-diabetic patients were hyperglycemic (p=0.001). Perioperative hyperglycemia was associated with mean age 54.3 year old, having 1 or more co-morbidity or mean admission glucose 13.1 mmol/L (p=0.001). There were 12 early SSI giving infection rate 13.3%. Early SSI was associated with HGI 1.76 and more (p=0.001), patients with 1 or more co-morbidity (p=0.006), mean admission glucose of 9.63 mmol/L (p=0.001). Conclusion: Our study showed perioperative hyperglycemia in stable trauma patients with orthopaedic injuries were associated with SSI. More patients are needed to find association of other variables and more studies are required in determining the acceptable glucose level and optimal treatment of perioperative hyperglycemia in stable trauma patients.
How to Cite
All material submitted for publication is assumed to be submitted exclusively to the IIUM Medical Journal Malaysia (IMJM) unless the contrary is stated. Manuscript decisions are based on a double-blinded peer review process. The Editor retains the right to determine the style and if necessary, edit and shorten any material accepted for publication.
IMJM retain copyright to all the articles published in the journal. All final ‘proof’ submissions must be accompanied by a completed Copyright Assignment Form, duly signed by all authors. The author(s) or copyright owner(s) irrevocably grant(s) to any third party, in advance and in perpetuity, the right to use, reproduce or disseminate the research article in its entirety or in part, in any format or medium, provided that no substantive errors are introduced in the process, proper attribution of authorship and correct citation details are given, and that the bibliographic details are not changed. If the article is reproduced or disseminated in part, this must be clearly and unequivocally indicated.