Persistent postoperative hyperglycemia as a risk factor for operative treatment of deep wound infection after spine surgery

Zach Pennington, Daniel Lubelski, Erick M. Westbroek, A. Karim Ahmed, Peter G. Passias, Daniel M. Sciubba

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Surgical site infections (SSIs) affect 1% to 9% of all spine surgeries. Though previous work has found diabetes mellitus type 2 (DM2) to increase the risk for wound infection, the influence of perioperative hyperglycemia is poorly described. OBJECTIVE: To investigate perioperative hyperglycemia as an independent risk factor for surgical site infection. METHODS: We retrospectively identified patients undergoing operative management of SSIs occurring after spinal surgery for degenerative pathologies. These patients were individually matched to controls based upon age, surgical invasiveness, ICD-10CM, race, and sex. Cases and controls were compared regarding medical comorbidities (including diabetes), postoperative hyperglycemia, and operative time. RESULTS: Patients in the infection group were found to have a higher BMI (33.7 vs 28.8), higher prevalence of DM2 (48.5% vs 14.7%), and longer inpatient stay (8.8 vs 4.3 d). They also had higher average (136.6 vs 119.6 mg/dL) and peak glucose levels (191.9 vs 153.1 mg/dL), as well as greater variability in glucose levels (92.1 vs 58.1 mg/dL). Multivariable logistic regression identified BMI (odds ratio [OR] = 1.13), diabetes mellitus (OR = 2.12), average glucose on the first postoperative day (OR = 1.24), peak postoperative glucose (OR = 1.31), and maximal daily glucose variation (OR = 1.32) as being significant independent predictors of postoperative surgical site infection. CONCLUSION: Postoperative hyperglycemia and poor postoperative glucose control are independent risk factors for surgical site infection following surgery for degenerative spine disease. These data suggest that, particularly among high-risk diabetic patients, strict perioperative glucose control may decrease the risk of SSI.

Original languageEnglish (US)
Pages (from-to)211-219
Number of pages9
JournalNeurosurgery
Volume87
Issue number2
DOIs
StatePublished - Aug 1 2020

Keywords

  • Diabetes mellitus
  • Glycemic control
  • Revision surgery
  • Surgical site infection
  • Wound infection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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