title: Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database.
abstract: OBJECTIVE
  Our objective was to assess the relationship between high blood glucose levels (BG) in the early postoperative period and the incidence of surgical site infections (SSIs), sepsis, and death following colorectal operations.
  
  
  METHODS
  The Michigan Surgical Quality Collaborative database was queried for colorectal operations from July 2012 to December 2013. Normoglycemic (BG < 180 mg/dL) and hyperglycemic (BG ≥ 180 mg/dL) groups were defined by using the highest BG within the first 72 h postoperatively. Outcomes of interest included the incidence of superficial, deep, and organ/space SSIs, sepsis, and death within 30 days. Initial unadjusted analysis was followed by propensity score matching and multiple logistic regression modeling after adjusting for significant predictors. Separate analyses were performed for previously diagnosed diabetic and non-diabetic patients.
  
  
  RESULTS
  A total of 5145 cases met inclusion criteria, of which 1072 were diabetic. For diabetic patients, there was a marginally significant association between high BG and superficial SSI in the unadjusted analysis (OR = 1.75, p = 0.056), but not in the adjusted analysis (OR = 1.35, p = 0.39). There was no significant relationship between elevated BG and deep SSI, organ/space SSI, sepsis, or death among diabetic patients. For non-diabetic patients, there was a significant association between high BG and superficial SSI (OR = 1.53, p = 0.03), sepsis (OR = 1.61, p < 0.01), and death (OR = 2.26, p < 0.01), but not deep or organ/space SSI.
  
  
  CONCLUSIONS
  Following colorectal operations, superficial SSI, sepsis, and death are associated with postoperative serum hyperglycemia in patients without diabetes, but not those with diabetes. Vigilant postoperative BG monitoring is critical for all patients undergoing colorectal surgery.
authors.affiliation: Department of Surgery, University of Massachusetts, Worcester, MA, USA. sathish.mohan@umassmemorial.org.|University of Massachusetts Medical School, S3-824, 55 Lake Avenue North, Worcester, MA, 01655, USA. sathish.mohan@umassmemorial.org.
authors.forename: Sathish
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Kaoutzanis
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Welch
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Vandewarker
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Winter
authors.affiliation: Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Greta
authors.initials: G
authors.lastname: Krapohl
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Lampman
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Franz
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Cleary
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery; D048909:Diabetes Complications / Q000097:blood; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012002:Rectal Diseases / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D018805:Sepsis / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: Death; High blood glucose; Postoperative hyperglycemia; Sepsis; Surgical site infection