Two recent studies in the July issues of the Journal of Bone and Joint Surgery (JBJS) looked at surgical site infections and hyperglycemia, the technical term for high blood glucose, or high blood sugar. According to the first study "Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery," high blood sugar is a concern during the post-traumatic and post-operative period and it may help to preoperatively identify a population of patients with musculoskeletal injuries who are at significant risk for infectious complications.
Nearly, one-third of patients who are admitted to the hospital without a history of diabetes have hyperglycemia, which is associated with a longer hospital stay, higher rates of admission to the intensive care unit (ICU), and increased mortality.
Study authors reviewed data on patients 18 years or older who had isolated orthopaedic injuries requiring acute operative intervention. Patients diagnosed with diabetes or who were in the ICU were not included in the study.
Of 790 patients, there were 268 open fractures (if the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone), and 21 surgical-site infections (SSIs) at 30-day follow-up. Age, race, comorbidities, injury severity, and blood transfusion were not associated with SSI at 30 days.
Specific study details: SSIs developed in 13 of 294 patients (4.4 percent) who had more than one glucose value greater than or equal to 200 mg/dL and 8 of 496 patients (1.6 percent) without more than one glucose value greater than or equal to 200 mg/dL. The authors concluded that hyperglycemia was an independent risk factor for thirty-day SSI in orthopaedic trauma patients without a history of diabetes.
This study suggests that recognition of the relationship between hyperglycemia and infectious complications may substantially influence post-operative care of orthopaedic patients. Large, prospective, randomized studies are necessary to further delineate this relationship.