Study on Perioperative Glycemic Control and Postoperative Infections

OBJECTIVE: To study the effects of perioperative glycemic control and their impact on postoperative infections in various general surgical procedures in patients with diabetes mellitus. BACKGROUND: Patients with diabetes are more likely to undergo various surgical procedures than non-diabetics. Perioperative glycaemic control in diabetics is challenging and leads to lesser postoperative infectious complications. This study helps to establish the significance of strict glycaemic control in these patients. METHODS: A prospective study of 50 diabetic patients undergoing various surgical procedures was done for the association of perioperative glycaemic control and the incidence of postoperative infections for a 30-day period during the period, from 1.1.2014 to 30.06.2014 in Thanjavur Medical College. The stastical significance and the overall incidence of postoperative infections were analysed with the amount of glycaemic control achieved. RESULTS: Of the 50 patients, 28 were males and 22 females. The mean age of the study is 54 years. 35 patients of elective surgery and 15 patients of emergency surgery were included. Mean plasma glucose concentration in the perioperative period calculated and patients were divided into four quartiles (I-120-180 mg/dl; II-181 to 220 mg/dl; III-221 to 260 mg/dl; IV-261 to 350 mg/dl) accordingly. The incidence of SSIs in each quartile (I-IV) was 16.7%, 54.5%, 66.7% & 100% respectively. 13.3%, 18.2% 33.3% & 66.7% incidence of pneumonia and 6.7%, 9.1%, 16.7% & 33.3% incidence of UTI occurred in quartile I to quartile IV respectively. Similarly the rate of occurrence of sepsis is 18.2% in II, 33.3% in III and 66.7% in IV quartile with no sepsis in I quartile patients. The overall incidence of postoperative infectious complications in each quartile from I to IV is 36.7%, 72.7%, 83.3% and 100% respectively. SSI accounted for the most common and sepsis for the least common complication in these patients. Insulin therapy proved to be a better way to achieve glycaemic control in these patients. The optimal glycaemic range desired is between 120 to 180 mg/dl. CONCLUSION: Good perioperative glycaemic control is associated with a decrease in postoperative infectious complications in diabetic patients undergoing various surgical procedures