Sat., 10/10/09 Basic Sci./Injury Prevent./Spine, Paper #73, 11:24 am OTA-2009
Does Stress Induced Hyperglycemia Increase the Risk of Perioperative Infectious Complications in Nondiabetic Orthopaedic Trauma Patients?
Madhav A. Karunakar, MD1 (7-National Highway Traffic Safety Administration);
Kurtis S. Staples, MD2 (7-National Highway Traffic Safety Administration);
1Carolinas Medical Center, Charlotte, North Carolina, USA;
2The CORE Institute, Phoenix, Arizona, USA
Purpose: Stress-induced hyperglycemia is poorly understood, but is believed to represent a natural intrinsic response to injury that results in the alteration of endogenous hormone production and metabolites. Both the incidence and whether this physiologic response hyperglycemia is protective or harmful to the posttrauma patient are unknown. We hypothesized that perioperative hyperglycemia in nondiabetic orthopaedic trauma patients is associated with an increased rate of infectious complications.
Methods: A retrospective review of 125 consecutive patients identified 15 diabetic and 110 nondiabetic orthopaedic trauma patients. The hyperglycemic index (HGI) was calculated for each patient using the method described by Vogelzang et al. Perioperative infections were categorized as pneumonia, urinary tract, sepsis/bacteremia, and/or wound infection. The patients were divided into 2 subgroups based on HGI: <3.0 or ≥3.0 (correlates with a mean serum glucose >220 mg/dL). The incidence of infections was calculated considering the following independent variables: ISS, body mass index, HGI, gender, and presence of open fracture. Means were compared using 2-sample t tests, and percentages were compared using either chi-square or Fisher exact tests.
Results: 46 infections occurred in 28 nondiabetic patients, including 11 wound infections, 17 pneumonia, 11 urinary tract infections, and 7 sepsis or bacteremia. The overall infection rate for the nondiabetic cohort was 28 of 110 (25%). No associations were identified between open fracture, gender, body mass index, ISS, and the presence of any infection. No associations were identified between open fracture and the presence of a wound infection. 99 patients had an HGI <3.0; 21 (21%) of these had a perioperative infection. 11 patients had an HGI ≥3.0; 7 (64%) of these had a perioperative infection. This difference was significant (P = 0.0056.
Conclusions: Perioperative hyperglycemia in nondiabetic orthopaedic trauma patients was associated with a 3-times higher risk of postoperative infectious complications. A recent study reported a 14% incidence of stress-induced hyperglycemia in a series of over 1,000 nondiabetic trauma patients. Based on this reported incidence and the findings of the present series, it appears that a significant number of nondiabetic trauma patients may experience hyperglycemia at levels that increase their risk of developing an infectious complication. Further prospective studies are needed to study the effects of stress-induced hyperglycemia and to determine whether this physiological response is protective or detrimental to the postoperative trauma patient.
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