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Persistent Postoperative Hyperglycemia as a Risk Factor for Operative Treatment of Deep Wound Infection After Spine Surgery.

Authors
  • Pennington, Zach1
  • Lubelski, Daniel1
  • Westbroek, Erick M1
  • Ahmed, A Karim1
  • Passias, Peter G2
  • Sciubba, Daniel M1
  • 1 Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • 2 Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York.
Type
Published Article
Journal
Neurosurgery
Publication Date
Aug 01, 2020
Volume
87
Issue
2
Pages
211–219
Identifiers
DOI: 10.1093/neuros/nyz405
PMID: 31555808
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Surgical site infections (SSIs) affect 1% to 9% of all spine surgeries. Though previous work has found diabetes mellitus type 2 (DM2) to increase the risk for wound infection, the influence of perioperative hyperglycemia is poorly described. To investigate perioperative hyperglycemia as an independent risk factor for surgical site infection. We retrospectively identified patients undergoing operative management of SSIs occurring after spinal surgery for degenerative pathologies. These patients were individually matched to controls based upon age, surgical invasiveness, ICD-10CM, race, and sex. Cases and controls were compared regarding medical comorbidities (including diabetes), postoperative hyperglycemia, and operative time. Patients in the infection group were found to have a higher BMI (33.7 vs 28.8), higher prevalence of DM2 (48.5% vs 14.7%), and longer inpatient stay (8.8 vs 4.3 d). They also had higher average (136.6 vs 119.6 mg/dL) and peak glucose levels (191.9 vs 153.1 mg/dL), as well as greater variability in glucose levels (92.1 vs 58.1 mg/dL). Multivariable logistic regression identified BMI (odds ratio [OR] = 1.13), diabetes mellitus (OR = 2.12), average glucose on the first postoperative day (OR = 1.24), peak postoperative glucose (OR = 1.31), and maximal daily glucose variation (OR = 1.32) as being significant independent predictors of postoperative surgical site infection. Postoperative hyperglycemia and poor postoperative glucose control are independent risk factors for surgical site infection following surgery for degenerative spine disease. These data suggest that, particularly among high-risk diabetic patients, strict perioperative glucose control may decrease the risk of SSI. Copyright © 2019 by the Congress of Neurological Surgeons.

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