Surgery in Diabetic Patients
Furnary AP, Zerr KJ. Grunkemeier GL, et al [ Providence St. Vincent Med Ctr., Portland, Ore]
Continuous Intravenous Insulin Infusion Reduced Incidence of Deep Sternal Wound Infection in Diabetic Patients After Cardiac Surgical Procedures
Ann Thorac Surg 67: 352-362, 1999
Deep Sternal Wound Infection [DSWI] is a very serious complication of cardiac surgery, and diabetes is an important risk factor. A new protocol to prevent DSWI in patients with diabetes, focusing on aggressive control of postoperative blood glucose levels by continuous insulin infusion [CII] was evaluated.
The prospective study included 2 consecutive groups of diabetic patients undergoing open heart surgery. The first group included 968 patients treated between 1987 and 1991. In this group, postoperative glucose control was achieved by using intermittent subcutaneous insulin injections, every 4 hours to maintain a target blood glucose level of less than 200 mg/dL. The second group of 1499 patients operated on between 1991 to 1997, received postoperative CII, to maintain blood glucose levels between 150 and 200 mg/dL.
The two groups were similar in their preoperative and intra-operative characteristics. The overall incidence of DSWI was 1.3%. Three fourths of these occurred after discharge. The control of blood glucose was better in the CII group; incidence of DSWI was significantly lower in this group, 0.8% vs.1.9%.
A policy of aggressive glucose control with CII significantly reduced the incidence of DSWI, to equal that in non-diabetics, thus reducing considerably the high costs of readmission and mortality associated with DSWI in diabetic patients.