title: Use of a postoperative insulin protocol decreases wound infection in diabetics undergoing lower extremity bypass.
abstract: OBJECTIVE
  Strict glucose control in patients undergoing coronary bypass grafting has been shown to decrease infectious complications, arrhythmias, and mortality. Our objective was to determine if strict glucose control reduced morbidity after lower extremity bypass (LEB).
  
  
  METHODS
  A prospective pilot study at a single institution within the Vascular Study Group of New England was conducted from January 2009 to December 2010. Patients with diabetes and without undergoing LEB were placed on an intravenous (IV) insulin infusion for 3 days after surgery with titration of blood glucose from 80 to 150 mg/dL. The IV insulin study group (n = 104) was compared to a historic control group (n = 189) that received standard insulin treatment from the preceding 3 years. The Fisher exact test, t-tests, Wilcoxon rank-sum tests, χ(2), and logistic regression analyses were used to compare in-hospital morbidity. Stratified analyses were conducted to determine if findings differed based on the presence or absence of diabetes.
  
  
  RESULTS
  There was no difference in postoperative complications between the two groups with regard to graft infection, myocardial infarction, dysrhythmia, primary patency at discharge, or mortality. Patients in the IV insulin group had significantly fewer in-hospital wound infections (4% vs 11%; odds ratio [OR], 0.32; 95% confidence interval [CI], 0.11-0.96; P = .047). This association strengthened after adjusting for potentially confounding baseline differences in gender, body mass index, and smoking status (adjusted OR, 0.22; 95% CI, 0.05-0.84; P = .03). When stratified by presence of diabetes, wound infections were decreased in the IV insulin group (0/44 [0%] vs 9/90 [10%]; P = .03). In patients without diabetes treated with IV insulin, there was no significant difference in wound infections (7% vs 12%; P = .42).
  
  
  CONCLUSIONS
  Strict glucose control with a postoperative insulin infusion protocol significantly decreased the incidence of postoperative in-hospital wound infection in the diabetic population. These previously unreported findings from this single-institution prospective study warrant further investigation.
authors.affiliation: Department of Surgery, University of Vermont, Burlington, Vt., USA. fuyuki.hirashima@vtmednet.org
authors.forename: Fuyuki
authors.initials: F
authors.lastname: Hirashima
authors.forename: Reshma B
authors.initials: RB
authors.lastname: Patel
authors.forename: Julie E
authors.initials: JE
authors.lastname: Adams
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bertges
authors.forename: Peter W
authors.initials: PW
authors.lastname: Callas
authors.forename: Georg
authors.initials: G
authors.lastname: Steinthorsson
authors.forename: Janet
authors.initials: J
authors.lastname: McSorley
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Stanley
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D003925:Diabetic Angiopathies / Q000097:blood / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000601:surgery*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000097:blood / Q000517:prevention & control*; D014656:Vascular Surgical Procedures
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin