Intraoperative hyperglycemia and postoperative bacteremia in the pediatric cardiac surgery patient.
BACKGROUND
Intraoperative hyperglycemia has been found to be associated with a higher incidence of postoperative infections in the adult cardiac surgery population. The goal of this study was to determine the association of intraoperative hyperglycemia and postoperative bacteremia in the pediatric population.


METHODS
A retrospective chart review of all cardiac surgical cases for patients 18 years of age or younger requiring cardiopulmonary bypass support between June 2002 and July 2007 yielded 1,132 total cases representing 992 unique patients. Patient demographic and clinical data of interest were collected. Descriptive statistics and regression analyses were performed to investigate the hypothesized relationship between glucose levels and infection rates.


RESULTS
From the 992 patient records examined, 15 patients exhibited a bacteremia within 14 days of surgery (1.5%). The association between the highest glucose during cardiopulmonary bypass and bacteremia reached statistical significance when the glucose level reached 175 mg/dL (chi(2) = 4.59, 1 degree of freedom; p = 0.032). A patient was more than three times as likely to have a postoperative bacteremia when the glucose level reached this amount or exceeded it (odds ratio, 3.3, 95% confidence interval, 1.04 to 10.39). Ten of the 15 (66.7%) postoperative infections occurred in patients with peak bypass glucose levels of at least 175 mg/dL.


CONCLUSIONS
Intraoperative hyperglycemia was found to be associated with a higher risk of postoperative bacteremia in the pediatric cardiac surgery population.
O'Brien
James E
JE
Cardiovascular and Thoracic Surgery Department, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA. jobrien@cmh.edu
Marshall
Jennifer A
JA
Tarrants
Marcy L
ML
Stroup
Richard E
RE
Lofland
Gary K
GK
D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology*; D001786:Blood Glucose / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D013223:Statistics as Topic
D001786:Blood Glucose