title: Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients.
abstract: OBJECTIVE
  SSI rates after gynecologic oncology surgery vary from 5% to 35%, but are up to 45% in patients with diabetes mellitus (DM). Strict postoperative glucose control by insulin infusion has been shown to lower morbidity, but not specifically SSI rates. Our project studied continuous postoperative insulin infusion for 24h for gynecologic oncology patients with DM and hyperglycemia with a target blood glucose of <139 mL/dL and a primary outcome of the protocol's impact on SSI rates.
  
  
  METHODS
  We compared SSI rates retrospectively among three groups. Group 1 was composed of patients with DM whose blood glucose was controlled with intermittent subcutaneous insulin injections. Group 2 was composed of patients with DM and postoperative hyperglycemia whose blood glucose was controlled by insulin infusion. Group 3 was composed of patients with neither DM nor hyperglycemia. We controlled for all relevant factors associated with SSI.
  
  
  RESULTS
  We studied a total of 372 patients. Patients in Group 2 had an SSI rate of 26/135 (19%), similar to patients in Group 3 whose rate was 19/89 (21%). Both were significantly lower than the SSI rate (43/148, 29%) of patients in Group 1. This reduction of 35% is significant (p = 0.02). Multivariate analysis showed an odd ratio = 0.5 (0.28-0.91) in reducing SSI rates after instituting this protocol.
  
  
  CONCLUSIONS
  Initiating intensive glycemic control for 24h after gynecologic oncology surgery in patients with DM and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics.
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA. Electronic address: alniaimi@wisc.edu.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Al-Niaimi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, 3851 Roger Brook Drive, Fort Sam, Houston, TX 78234, USA.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
authors.forename: Nikki
authors.initials: N
authors.lastname: Burish
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
authors.forename: Saygin A
authors.initials: SA
authors.lastname: Chackmakchy
authors.affiliation: Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison WI, USA.
authors.forename: Songwon
authors.initials: S
authors.lastname: Seo
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rose
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hartenbach
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Kushner
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
authors.forename: Laurel
authors.initials: L
authors.lastname: Rice
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Connor
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005833:Genital Neoplasms, Female / Q000097:blood / Q000150:complications / Q000601:surgery*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000097:blood* / Q000517:prevention & control*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Diabetes mellitus; Gynecologic oncology surgery; Intensive glycemic control; Post operative morbidity; Surgical outcome; Surgical site infection