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The impact of poor post-operative glucose control on neurosurgical surgical site infections (SSI)
Journal of Clinical Neuroscience ( IF 2 ) Pub Date : 2021-09-02 , DOI: 10.1016/j.jocn.2021.08.024
Trisha Weber 1 , Bin Ge 2 , Tomoko Tanaka 3 , N Scott Litofsky 1
Affiliation  

Elevated HbA1c is associated with increased surgical site infections (SSI) in neurosurgical patients. How blood glucose control in the early post-operative period relates to SSI is incompletely understood. We hypothesized that poor early post-operative blood glucose control would be associated with SSI. Data from patients undergoing neurosurgical procedures at University of Missouri Hospital was retrospectively collected. Post-operative blood glucose for 72 h after surgery was assessed and categorized by levels of hyperglycemia; those with glucose ≥200 mg/dl were classified as poorly controlled. Patients with SSI were compared to patients without SSI using Chi-Square test with Fisher’s exact test when appropriate. Of 500 patients having surgery, 300 had at least one post-operative blood glucose measurement. Of those 300 patients, 19 (6.33%) developed SSI. Patients with SSI had significantly higher mean post-operative blood glucose levels (p = 0.0081) and a greater mean number of point-of-care glucose level measurements >150 mg/dL (p = 0.0434). Pre-operative HbA1c and SSI were not associated (p = 0.0867). SSI was associated with pre-operative glucocorticoid use (p = 0.03), longer operative procedure (p = 0.0072), and required use of post-operative insulin drip (p = 0.047). Incidence of other wound complications (cellulitis, deep infection, dehiscence) increased with increase in post-operative blood glucose levels to >225 mg/dL. Post-operative hyperglycemia is associated with SSI after neurosurgical procedures, emphasizing the importance addressing blood glucose control after surgery.



中文翻译:

术后血糖控制不佳对神经外科手术部位感染 (SSI) 的影响

HbA1c 升高与神经外科患者的手术部位感染 (SSI) 增加有关。术后早期血糖控制与 SSI 之间的关系尚不完全清楚。我们假设术后早期血糖控制不佳与 SSI 相关。回顾性收集了在密苏里大学医院接受神经外科手术的患者的数据。评估术后 72 h 的术后血糖并按高血糖水平分类;那些血糖≥200 mg/dl 的患者被归类为控制不佳。在适当的时候,使用卡方检验和 Fisher 精确检验将 SSI 患者与没有 SSI 的患者进行比较。在 500 名接受手术的患者中,300 名至少进行了一次术后血糖测量。在这 300 名患者中,有 19 名 (6. 33%) 开发了 SSI。SSI 患者术后平均血糖水平显着升高 (p = 0.0081),并且床旁血糖水平测量值的平均次数大于 150 mg/dL (p = 0.0434)。术前 HbA1c 和 SSI 不相关(p = 0.0867)。SSI 与术前使用糖皮质激素 (p = 0.03)、更长的手术时间 (p = 0.0072) 和需要使用术后滴注胰岛素 (p = 0.047) 相关。其他伤口并发症(蜂窝织炎、深部感染、裂开)的发生率随着术后血糖水平升高至 >225 mg/dL 而增加。术后高血糖与神经外科手术后的 SSI 相关,强调了解决术后血糖控制的重要性。SSI 患者术后平均血糖水平显着升高 (p = 0.0081),并且床旁血糖水平测量值的平均次数大于 150 mg/dL (p = 0.0434)。术前 HbA1c 和 SSI 不相关(p = 0.0867)。SSI 与术前使用糖皮质激素 (p = 0.03)、更长的手术时间 (p = 0.0072) 和需要使用术后滴注胰岛素 (p = 0.047) 相关。其他伤口并发症(蜂窝织炎、深部感染、裂开)的发生率随着术后血糖水平升高至 >225 mg/dL 而增加。术后高血糖与神经外科手术后的 SSI 相关,强调了解决术后血糖控制的重要性。SSI 患者术后平均血糖水平显着升高 (p = 0.0081),并且床旁血糖水平测量值的平均次数大于 150 mg/dL (p = 0.0434)。术前 HbA1c 和 SSI 不相关(p = 0.0867)。SSI 与术前使用糖皮质激素 (p = 0.03)、更长的手术时间 (p = 0.0072) 和需要使用术后滴注胰岛素 (p = 0.047) 相关。其他伤口并发症(蜂窝织炎、深部感染、裂开)的发生率随着术后血糖水平升高至 >225 mg/dL 而增加。术后高血糖与神经外科手术后的 SSI 相关,强调了解决术后血糖控制的重要性。术前 HbA1c 和 SSI 不相关(p = 0.0867)。SSI 与术前使用糖皮质激素 (p = 0.03)、更长的手术时间 (p = 0.0072) 和需要使用术后滴注胰岛素 (p = 0.047) 相关。其他伤口并发症(蜂窝织炎、深部感染、裂开)的发生率随着术后血糖水平升高至 >225 mg/dL 而增加。术后高血糖与神经外科手术后的 SSI 相关,强调了解决术后血糖控制的重要性。术前 HbA1c 和 SSI 不相关(p = 0.0867)。SSI 与术前使用糖皮质激素 (p = 0.03)、更长的手术时间 (p = 0.0072) 和需要使用术后滴注胰岛素 (p = 0.047) 相关。其他伤口并发症(蜂窝织炎、深部感染、裂开)的发生率随着术后血糖水平升高至 >225 mg/dL 而增加。术后高血糖与神经外科手术后的 SSI 相关,强调了解决术后血糖控制的重要性。裂)随着术后血糖水平升高至 >225 mg/dL 而增加。术后高血糖与神经外科手术后的 SSI 相关,强调了解决术后血糖控制的重要性。裂)随着术后血糖水平升高至 >225 mg/dL 而增加。术后高血糖与神经外科手术后的 SSI 相关,强调了解决术后血糖控制的重要性。

更新日期:2021-09-02
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