Perioperative hyperglycaemia as a risk factor for early surgical-site infection in stable trauma patients in orthopaedic unit

Abstract

This study is to evaluate the association between perioperative hyperglycaemia and early surgical-site infection (SSI) in stable trauma patients with orthopaedic injuries. This is an observational cohort study conducted in Hospital Sultanah Nur Zahirah, Kuala Terengganu over 15 months. Patients age of 18 years and older with operative orthopaedic injuries were included in this study. Patients with steroid use, multisystem injuries, critically ill or unstable and patients with perioperative infection were excluded. Demographics, medical comorbidities, body mass index, type of fracture, HbA1c level in diabetic patients and length of hospital stay were recorded. Finger prick glucose values were obtained twice daily. Perioperative hyperglycaemia was defined by hyperglycaemic index (HGI) greater than 1.76 during the hospital stay. SSI was defined by gross intraoperative signs of infection or positive intraoperative culture at reoperation within 30 days, gross purulent discharged or superficial infection requiring an intravenous antibiotic. The categorical data were analysed using the chi-square test while continuous data were analysed using T-test. A total of 90 patients were enrolled in which 15 were diabetic and 75 were non-diabetic. Among hyperglycaemia patients, 10 patients were diabetic and only one was non-diabetic (p = <0.001). Perioperative hyperglycaemia was associated with mean age 54.3 year old, having one or more co-morbidity or mean admission glucose 13.1 mmol/L (p = <0.001). There were 12 early SSI giving an infection rate of 13.3%. Early SSI was associated with HGI 1.76 and more (p = <0.001), patients with 1 or more co-morbidity (p = 0.006), mean admission glucose of 9.63 mmol/L (p = <0.001). These study concluded that perioperative hyperglycaemia in stable trauma patients with orthopaedic injuries was associated with early SSI.