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Allied Afflictions Studies link hyperglycemia and obesity to a higher risk
of surgical-site infection. H
yperglycemia can be an inde- pendent risk factor for 30-day
surgical-site infection in orthopedic trauma patients without a history of diabetes, according to study results published in The Journal of Bone and Joint Surgery last year.
The researchers studied 790 pa- tients, 18 or older, with isolated or- thopedic injuries that required acute operative intervention. They excluded patients with diabetes, injuries to other body systems, a history of corticoste- roid use and admission to the intensive care unit from the study. The patients’ blood glucose values were obtained, and hyperglycemia was defined in two ways. First, patients with two or more blood glucose levels of ≥200 mg/dL were identified. Second, the hypergly- cemic index, a validated measure of overall glucose control during hospi- talization, was calculated for each pa- tient. A hyperglycemic index of ≥1.76 (equivalent to ≥140 mg/dL) was con- sidered to indicate hyperglycemia. The researchers recorded 21 30-
day surgical-site infections (2.7 per- cent). Of the 790 patients, 294 (37.2 percent) had more than one glucose value of ≥200 mg/dL. This factor was associated with 30-day surgical-site infection, with 13 (4.4 percent) of the 294 patients with that indication of hyperglycemia having a surgical-site infection versus eight (1.6 percent) of the 496 patients without more than one glucose value of ≥200 mg/dL (p = 0.02). One hundred and thirty-four (17 percent) of the 790 patients had a hyperglycemic index of ≥1.76, and this was also associated with 30-day surgi- cal-site infection (10 [7.5 percent] of 134 versus 11 [1.7 percent] of 656). A second study also reported in The Journal of Bone and Joint Surgery
34 ASC FOCUS APRIL 2013
last year, concluded that diabetes and morbid obesity increased the risk of periprosthetic joint infection follow- ing primary hip and knee replacement. That study also suggests that the ben- efits of joint replacement should be weighed carefully against the risks of of postoperative infection, especially in morbidly obese patients. Researchers analyzed the one-year incidence of periprosthetic joint infec- tions in a single-center series of 7,181 primary hip and knee replacements (unilateral and simultaneous bilateral) performed between 2002 and 2008 to treat osteoarthritis. They collected the data regarding periprosthetic joint in- fection (defined according to Centers for Disease Control and Prevention criteria) from the hospital infection register and based it on prospective, active surveillance. They calculated the odds of infection and the accompa- nying 95 percent confidence intervals with binary logistic regression with adjustment for age, sex, American So- ciety of Anesthesiologists risk score,
arthroplasty site, body mass index and diabetic status. Fifty-two periprosthetic joint in- occurred
fections during the first
postoperative year. The infection rate increased from 0.37 percent in pa- tients with a normal body mass index to 4.66 percent in the morbidly obese group. Diabetes more than doubled the periprosthetic joint infection risk independent of obesity. The infection rate was highest in morbidly obese patients with diabetes, a group of 51 patients that saw periprosthetic infection develop in five. In patients without a diagnosis of diabetes at the time of the surgery, there was a trend toward a higher infection rate in as- sociation with a preoperative glucose level of ≥6.9 mmol/L (124 mg/dL) compared with ≥6.9 mmol/L. The in- fection rate was 1.15 percent in the former group compared with 0.28 percent in the latter. The type of dia- betes medication was not associated with the infection rate.
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