Diabetes and Subsequent Risks for Surgical Site Infection



Diabetes and Subsequent Risks for Surgical Site Infection

Surgical site infections (SSI) pose an ongoing problem in surgical practice. They lead to patient dissatisfaction, delayed wound healing, and increased risk of incisional hernias, extended length of hospital stay (LOS), and an increased risk of other nosocomial complications. Furthermore, there is an increased expense associated with SSI. The CDC estimates an additional cost of $2,734 to $26,019 to the American health care system per SSI, with an annual figure estimated between $130 million and $845 million. Therefore, reducing the incidence of SSIs is important in improving both the individual patient's health and reducing the overall cost of health care. Patients undergoing colorectal resection are at an increased risk for developing SSI due to the bacterial load of the colon. The incidence of SSIs after colorectal resection ranges from 3% to 30%. A wide variety of risk factors thought to play a role in the pathogenesis of SSIs have been studied. Obesity, steroid use, anemia, bowel preparation, hypothermia, nutritional status, and blood transfusion are some of the factors considered to be associated with development of an SSI (Alserius, 2008).

The Center for Medicare and Medicaid Services (CMS) has implemented protocols for prophylactic antibiotic choice, timing of administration, and duration of use aimed at reducing SSI, but as of yet it is unclear if these interventions have had a significant impact. Diabetes mellitus (DM) has been shown to play a significant predisposing role for SSIs in many surgical disciplines such as orthopaedic, cardiac, and general surgery. Poor glycemic control, especially in the immediate postoperative period, has been associated with an increased incidence of SSI. The American Diabetes Association (ADA) has recommended that perioperative blood glucose levels be kept below 200 mg/dL to minimize SSI. However, in this higher risk group of DM patients, it is unclear what other factors play a role in SSI occurrence. For example, whether severity of DM defined by the need for insulin versus oral agents, or whether prolonged use of prophylactic antibiotics might alter SSI incidence is unknown. The purpose of this study was to investigate other potential risk factors in the development of SSIs in this high risk diabetic group undergoing colorectal resection (American Diabetes Association, 2012).

Diabetes mellitus affects an estimated 18 million Americans and costs $132 billion in annual expenditures in the United States. Equally disquieting, a substantial number of persons with diabetes (5.2 million individuals in the United States) have not been formally diagnosed, are unaware of their disease,1 and are subject to develop the same complications as those known to have diabetes. Diabetic persons, with their increased risk for atherosclerotic coronary disease and myocardial infarction, compose a substantial proportion of patients who require coronary artery bypass grafting (CABG), and the percentage of cardiac surgical patients with a history of diabetes has climbed steadily during the last decade, reaching 27.5% in 1994, the last year for which statistics were published (Ata, 2010). Diabetic patients present speci?c challenges in ...