Purpose: Despite growing interest in perioperative glycemic control, little data existdefining?the optimal value(s) to use to define appropriate glycemic management and the impact on the incidence of surgical site infection (SSI).?The aim of this study?was to assess variation in glycemic response and risk of SSI and hospital stay as defined by themaximum, minimum, and area under the curve for?perioperative glucose in patients undergoing?colectomy. We specifically used standard of care obtained glucose levels to reflect limitations of observations typically used to assess quality of care. Methods: All patients undergoing colectomy from 7/2007?to?6/2008 were assessed for the?maximum and minimum levels of standard of care glucose levels, as well as area under the curve (AUC) for?elevated glucose?perioperatively. These were assessed for patients with and without SSI?(SSI vs nSSI). Results: 183 consecutive patients were evaluated (22 diabetics). The incidence of SSI for?the entire?population was 17/183 (9.3%) without significant difference between the?groups with respect to mean?blood glucose level (SSI-136;nSSI-136). However, the SSI?group had a higher maximum glucose level?(SSI-194;nSSI 162;p??110?mg/dl (SSI-59%;nSSI-62%) or glucose >?150?mg/dl (SSI 6%;nSSI 18%). Conclusions: The data demonstrate that patients with SSI have wider fluctuations inglycemic response?compared to non-SSI when standard of care serum glucose levels?wasreviewed. Therefore, quality program monitoring of glucose impact on SSI should focus on both maximum and minimum levels during the perioperative period to better define process improvement in colectomy patients.
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