THE ASSOCIATION OF IMMEDIATE POST-OPERATIVE GLUCOSE LEVELS ON SSI FOLLOWING COLORECTAL SURGERY
Joseph P. Bethea*, Karen Kennamer, Seth Quinn, Brandon Peine, Katie Lovell, Jesse Mendes, Sydney Taylor, Yuanyuan Fu, Michael Honaker
Surgery, East Carolina University, Greenville, NC
Introduction
Diabetes is a well-known contributor to surgical site infections (SSIs) in colorectal surgery (CRS)1. However, the effect of elevated glucose levels in the immediate post-operative period on the outcomes of non-diabetic patients (NDP) is less understood. The purpose of this study was to compare blood glucose (BG) levels in the immediate post-operative period between diabetic patients (DP) and NDP and determine an association with SSI.
Methods
This was a pilot study with institutional IRB approval. A prospective collection of perioperative glucose levels was carried out for patients undergoing colorectal surgery at a single, tertiary institution over a one-year period. Blood glucose levels were measured at 30 minutes and 60 minutes post-operatively, upon discharge from PACU and on post-operative day one. Demographic and outcomes data were obtained for each patient. Surgical modalities of laparoscopic, robotic, open, and perineal were included for both benign and malignant pathologies. All perioperative BG levels were averaged for each patient. BG averages were compared between patients with diabetes and patients without diabetes in the immediate post-operative period. A Univariate Logistic Regression analysis was carried out for the outcomes: 30-day Readmission and SSI. A p-value of less than 0.05 was considered to be statistically significant.
Results
There were 267 patients included in the study. There were 97 DP and 170 NDP. For the outcomes of SSI and Readmission, using univariate analysis, the only significant difference was seen between readmission rates for open versus robotic surgery (table 1, table 2). The Median age was 62 for DP, and 59 for NDP. DP were 63.92% female NDP were 51.18% female (p=0.0438). The median BMI was 27.37 for DP and 31.28 for NDP (p=0.0014). The proportion of open, Ileostomy takedown, laparoscopic, and robotic cases was 24.4%, 16%, 24%, and 85% for NDP and 22.58%, 4%, 18%, and 50% for DP (p=0.361). The median BG average was 142 for NDP and 154 for DP (p=0.0007). Thirty-day readmission was 14.43% for DP and 12.65% for NDP (p= 0.6341). The rate of SSI was 7% for NDP and 4% for DP (p=1).
Conclusion
Although significantly different, NDP and DP had clinically similar average perioperative glucose levels. Both groups had average glucose levels above 140. With further study, we may find that decreasing perioperative glucose levels in non-diabetic patients may decrease rates of SSI.
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