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Severe Intraoperative Hyperglycemia Is Independently Associated With Postoperative Composite Infection After
Shaun E Gruenbaum1, Laura Toscani, Kenneth M Fomberstein
1From the *Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; †Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Rome, Italy; ‡Department of Anesthesiology, New York Medical College, Valhalla, New York; and §Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois.
Background:
Postoperative infection after craniotomy carries an increased risk of morbidity and mortality. Identification and correction of the risk factors should be prioritized. The association of intraoperative hyperglycemia with postoperative infections in patients undergoing craniotomy is inadequately studied.
Methods:
A total of 224 patients were prospectively enrolled in 2 major medical centers to assess whether severe intraoperative hyperglycemia (SIH, blood glucose ≥180 mg/dL) is associated with an increased risk of postoperative infection in patients undergoing craniotomy. Arterial blood samples were drawn and analyzed immediately after anesthetic induction and again before tracheal extubation. The new onset of any type of infection within 7 days after craniotomy was determined.
Results:
The incidence of new postoperative composite infection was 10% (n = 22) within the first week after craniotomy. Weight, sex, American Society of Anesthesiologists score, preoperative and/or intraoperative steroid use, and diabetes mellitus were not associated with postoperative infection. SIH was independently associated with postoperative infection (odds ratio [95% confidence interval], 4.17 [1.50-11.56], P = .006) after fitting a multiple logistic regression model to adjust for emergency surgery, length of surgery, and age ≥65 years.
Conclusions:
SIH is independently associated with postoperative new-onset composite infections in patients undergoing craniotomy. Whether prevention of SIH during craniotomy results in a reduced postoperative risk of infection is unknown and needs to be appraised by further study.
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