title: The role of pre-operative and post-operative glucose control in surgical-site infections and mortality.
abstract: OBJECTIVE
  The impact of glucose control on surgical-site infection (SSI) and death remains unclear. We examined how pre- and post-operative glucose levels and their variability are associated with the risk of SSI or in-hospital death.
  
  
  METHODS
  This retrospective cohort study employed data on 13,800 hospitalized patients who underwent a surgical procedure at a large referral hospital in New York between 2006 and 2008. Over 20 different sources of electronic data were used to analyze how thirty-day risk of SSI and in-hospital death varies by glucose levels and variability. Maximum pre- and post-operative glucose levels were determined for 72 hours before and after the operation and glucose variability was defined as the coefficient of variation of the glucose measurements. We employed logistic regression to model the risk of SSI or death against glucose variables and the following potential confounders: age, sex, body mass index, duration of operation, diabetes status, procedure classification, physical status, emergency status, and blood transfusion.
  
  
  RESULTS
  While association of pre- and post-operative hyperglycemia with SSI were apparent in the crude analysis, multivariate results showed that SSI risk did not vary significantly with glucose levels. On the other hand, in-hospital deaths were associated with pre-operative hypoglycemia (OR = 5.09, 95% CI (1.80, 14.4)) and glucose variability (OR = 1.14, 95% CI (1.03, 1.27) for 10% increase in coefficient of variation).
  
  
  CONCLUSIONS
  In-hospital deaths occurred more often among those with pre-operative hypoglycemia and higher glucose variability. These findings warrant further investigation to determine whether stabilization of glucose and prevention of hypoglycemia could reduce post-operative deaths.
authors.affiliation: School of Nursing, Columbia University School of Nursing, New York, NY, USA. christie.jeon@gmail.com
authors.forename: Christie Y
authors.initials: CY
authors.lastname: Jeon
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.forename: Mitchell F
authors.initials: MF
authors.lastname: Berman
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000097:blood* / Q000401:mortality
chemical_list: D001786:Blood Glucose