Severe intraoperative hyperglycemia is independently associated with surgical site infection after liver transplantation.
BACKGROUND
Surgical site infection (SSI) is a common postoperative complication associated with increased morbidity and mortality in patients undergoing liver transplantation (LT). Although intraoperative hyperglycemia has been shown to be associated with adverse postoperative outcomes including overall infection rate in LT patients, a relationship between intraoperative hyperglycemia and SSI in LT has not been established. We sought to determine if intraoperative hyperglycemia was associated with SSI after LT.


METHODS
Patients undergoing LT at our medical center between January 2004 and November 2007 were included in the study. Recipient, donor, and intraoperative variables including a variety of glucose indices were retrospectively analyzed. Independent risk factors of SSI were identified using a multivariate logistic regression model.


RESULTS
Of 680 patients, 76 (11.2%) experienced postoperative SSIs. Among all intraoperative glucose indices analyzed, severe hyperglycemia (>or= 200 mg/dL) was independently associated with postoperative SSI (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.26-4.03, P=0.006). Other independent risk factors include repeat surgery (OR 6.58, 95% CI 3.41-12.69, P<0.001), intraoperative administration of vasopressor (OR 3.14, 95% CI 1.65-5.95, P<0.001), preoperative mechanical ventilation (OR 3.01, 95% CI 1.70-5.33, P<0.001), and combined liver and kidney transplantation (OR 2.95, 95% CI 3.41-12.69, P<0.001).


CONCLUSIONS
Severe, but not mild or moderate, intraoperative hyperglycemia is independently associated with postoperative SSI and should be avoided during LT surgery.
Department of Anesthesiology, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7430, USA.
Chulsoo
C
Park
Chehao
C
Hsu
Gundappa
G
Neelakanta
Hamid
H
Nourmand
Michelle
M
Braunfeld
Christopher
C
Wray
Randolph H
RH
Steadman
Ke-Qin
KQ
Hu
Ronald T
RT
Cheng
Victor W
VW
Xia
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001803:Blood Transfusion; D005260:Female; D006400:Hematocrit; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000517:prevention & control; D007431:Intraoperative Complications / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000382:microbiology; D006435:Renal Dialysis; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000150:complications*
D001786:Blood Glucose