Al-Niaimi Ahmed N, Ahmed Mostafa, Burish Nikki, Chackmakchy Saygin A, Seo Songwon, Rose Stephen, Hartenbach Ellen, Kushner David M, Safdar Nasia, Rice Laurel, Connor Joseph
Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, 3851 Roger Brook Drive, Fort Sam, Houston, TX 78234, USA.
Gynecol Oncol. 2015 Jan;136(1):71-6. doi: 10.1016/j.ygyno.2014.09.013. Epub 2014 Sep 28.
SSI rates after gynecologic oncology surgery vary from 5% to 35%, but are up to 45% in patients with diabetes mellitus (DM). Strict postoperative glucose control by insulin infusion has been shown to lower morbidity, but not specifically SSI rates. Our project studied continuous postoperative insulin infusion for 24h for gynecologic oncology patients with DM and hyperglycemia with a target blood glucose of <139 mL/dL and a primary outcome of the protocol's impact on SSI rates.
We compared SSI rates retrospectively among three groups. Group 1 was composed of patients with DM whose blood glucose was controlled with intermittent subcutaneous insulin injections. Group 2 was composed of patients with DM and postoperative hyperglycemia whose blood glucose was controlled by insulin infusion. Group 3 was composed of patients with neither DM nor hyperglycemia. We controlled for all relevant factors associated with SSI.
We studied a total of 372 patients. Patients in Group 2 had an SSI rate of 26/135 (19%), similar to patients in Group 3 whose rate was 19/89 (21%). Both were significantly lower than the SSI rate (43/148, 29%) of patients in Group 1. This reduction of 35% is significant (p = 0.02). Multivariate analysis showed an odd ratio = 0.5 (0.28-0.91) in reducing SSI rates after instituting this protocol.
Initiating intensive glycemic control for 24h after gynecologic oncology surgery in patients with DM and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics.
妇科肿瘤手术后手术部位感染（SSI）发生率在5%至35%之间，但糖尿病（DM）患者的发生率高达45%。通过胰岛素输注进行严格的术后血糖控制已被证明可降低发病率，但并未特别降低SSI发生率。我们的项目研究了对患有DM和高血糖的妇科肿瘤患者进行24小时持续术后胰岛素输注，目标血糖<139 mL/dL，主要结果是该方案对SSI发生率的影响。
我们回顾性比较了三组患者的SSI发生率。第1组由通过皮下间断注射胰岛素控制血糖的DM患者组成。第2组由患有DM和术后高血糖且通过胰岛素输注控制血糖的患者组成。第3组由既无DM也无高血糖的患者组成。我们对与SSI相关的所有相关因素进行了控制。
我们共研究了372例患者。第2组患者的SSI发生率为26/135（19%），与第3组患者的发生率19/89（21%）相似。两者均显著低于第1组患者的SSI发生率（43/148，29%）。这种35%的降低具有显著性（p = 0.02）。多变量分析显示，实施该方案后降低SSI发生率的比值比=0.5（0.28 - 0.91）。
与接受间断胰岛素滑动剂量治疗的患者以及与非糖尿病患者相当的发生率相比，对患有DM和术后高血糖的妇科肿瘤患者在术后24小时开始强化血糖控制可使SSI发生率降低35%（OR = 0.5）。
