Section of Neurosurgery, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
Ann Surg. 2011 Jan;253(1):158-65. doi: 10.1097/SLA.0b013e3181f9bb3a.
Examine the relationship between perioperative glucose control and postoperative infections in a nationwide sample of diabetic patients undergoing a wide variety of surgical procedures.
Perioperative glucose control has been linked to postoperative infections after selected surgical procedures.
Retrospective analysis of surgical outcomes data from 1999 to 2004 on 55,408 patients with diabetes undergoing a variety of noncardiac operations contained in the Veterans Heath Administration National Surgical Quality Improvement Program database, supplemented with the Veterans Heath Administration Decision Support Services hemoglobin A1c (HbA(₁c)) and serum glucose data. Multivariate Poisson regression model of postoperative infection including demographics, comorbidities, functional status, preoperative laboratories, surgical data, and glucose control (diabetes medications, serum glucose, HbA(₁c), mean serum glucose within 24 hours after surgery).
The most common procedures were herniorrhaphy (10%), carotid endarterectomy (6.6%), and open colectomy (5.6%). Mean (SD) preoperative HbA1c concentration was 7.9% (2.3); 51% of patients had preoperative serum glucose concentrations more than 150 mg/dL; and 72% of patients had a mean 24 hour postoperative glucose concentration at least 150 mg/dL. The overall postoperative infection rate was 8.0%. Higher rates of postoperative infection were associated with mean 24 hour postoperative serum glucose concentrations of 150 to 250 mg/dL (incidence rate ratio 1.22, 95% confidence interval, 1.04-1.43; P = 0.01) and more than 250 mg/dL (incidence rate ratio: 1.43; 95% confidence interval, 1.19-1.71; P < 0.001). Preoperative HbA1c and glucose concentrations were not associated with increased infection rates.
In a large nationwide sample of diabetic patients undergoing a variety of noncardiac surgical procedures, glucose control in the first 24 hours after surgery was poor, and mean serum glucose concentrations of 150 mg/dL and higher during this time period were associated with increased rates of postoperative infectious complications.
在一个接受各种手术的糖尿病患者的全国性样本中，研究围手术期血糖控制与术后感染之间的关系。
围手术期血糖控制与某些手术后的术后感染有关。
对退伍军人事务部全国手术质量改进计划数据库中 1999 年至 2004 年期间 55408 例接受各种非心脏手术的糖尿病患者的手术结果数据进行回顾性分析，这些数据补充了退伍军人事务部决策支持服务糖化血红蛋白（HbA1c）和血清葡萄糖数据。采用多变量泊松回归模型对术后感染进行分析，包括人口统计学、合并症、功能状态、术前实验室、手术数据和血糖控制（糖尿病药物、血清葡萄糖、HbA1c、术后 24 小时内平均血清葡萄糖）。
最常见的手术是疝修补术（10%）、颈动脉内膜切除术（6.6%）和开放性结肠切除术（5.6%）。术前 HbA1c 浓度的平均值（标准差）为 7.9%（2.3）；51%的患者术前血清葡萄糖浓度超过 150mg/dL；72%的患者术后 24 小时平均血糖浓度至少为 150mg/dL。总的术后感染率为 8.0%。更高的术后感染率与术后 24 小时内 150-250mg/dL 的平均血清葡萄糖浓度相关（发生率比 1.22，95%置信区间 1.04-1.43；P=0.01）和超过 250mg/dL（发生率比 1.43，95%置信区间 1.19-1.71；P<0.001）。术前 HbA1c 和血糖浓度与感染率增加无关。
在一个接受各种非心脏手术的糖尿病患者的大型全国性样本中，术后 24 小时内的血糖控制较差，在此期间 150mg/dL 及以上的平均血清葡萄糖浓度与术后感染并发症发生率增加有关。
