Lai Jing, Li Qihong, He Ying, Zou Shiyue, Bai Xiaodong, Rastogi Sanjay
Department of Nursing, The First People's Hospital of Longquanyi District, Chengdu, China.
Department of Internal Medicine, Yantai Qishan Hospital, Yantai, China.
Front Surg. 2022 Mar 25;9:855409. doi: 10.3389/fsurg.2022.855409. eCollection 2022.
Increased risk of surgical site infections (SSIs) caused by hyperglycemia makes it necessary to follow perioperative glucose lowering strategies to reduce postoperative complications. A meta-analysis was conducted to understand the efficacy of intensive vs. conventional blood glucose lowering regimens on the incidence of SSIs and hypoglycemia from various randomized controlled studies (RCTs).
A systematic literature review was conducted using MEDLINE and Central databases for RCTs that involved intensive (lower blood glucose target levels) vs. conventional (higher blood glucose target levels) strategies in patients undergoing various types of surgeries. The primary outcomes were SSIs or postoperative wound infections. Hypoglycemia and mortality outcomes were also studied. A random-effects model was used to calculate the pooled risk ratio (RR), and subgroup analyses were performed.
A total of 29 RCTs were included in the meta-analysis with the information from 14,126 patients. A reduction in overall incidence of SSIs was found (RR 0.63, 0.50-0.80, = 0.0002, = 56%). Subgroup analyses showed that intensive insulin regimens decreased the risk of SSIs in patients with diabetes, in cardiac and abdominal surgical procedures, and during the intraoperative and postoperative phases of surgery. However, the risk of hypoglycemia and mortality was increased in the intensive group compared to the conventional group.
The results of the meta-analysis provide support for the use of intensive insulin regimens during the perioperative phase for decreasing the incidence of SSIs in certain patient populations and surgical categories.
高血糖导致手术部位感染（SSIs）风险增加，因此有必要采取围手术期降糖策略以减少术后并发症。进行了一项荟萃分析，以了解强化降糖方案与传统降糖方案相比，在各类随机对照试验（RCTs）中对SSIs发生率和低血糖的疗效。
使用MEDLINE和Central数据库对涉及各类手术患者的强化（较低血糖目标水平）与传统（较高血糖目标水平）策略的RCTs进行系统文献综述。主要结局为SSIs或术后伤口感染。还研究了低血糖和死亡率结局。采用随机效应模型计算合并风险比（RR），并进行亚组分析。
荟萃分析共纳入29项RCTs，涉及14,126例患者的信息。发现SSIs总体发生率降低（RR 0.63，0.50 - 0.80，P = 0.0002，I² = 56%）。亚组分析表明，强化胰岛素方案可降低糖尿病患者、心脏和腹部手术患者以及手术术中及术后阶段的SSIs风险。然而，与传统组相比，强化组低血糖和死亡风险增加。
荟萃分析结果支持在围手术期使用强化胰岛素方案，以降低特定患者群体和手术类型中SSIs的发生率。
