Extent of post-operative hyperglycaemia in the high-risk cases and its relation with post-operative infections during hospitalization

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Extent of post-operative hyperglycaemia in the high-risk cases and its relation with post-operative infections during hospitalization


Author: Yip, Wing-sim Ruby
Title: Extent of post-operative hyperglycaemia in the high-risk cases and its relation with post-operative infections during hospitalization
Degree: M.Sc.
Year: 2009
Subject: Hong Kong Polytechnic University -- Dissertations.
Postoperative care.
Surgery -- Complications.
Department: Dept. of Health Technology and Informatics
Pages: xi, 95 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2305532
URI: http://theses.lib.polyu.edu.hk/handle/200/4293
Abstract: Diabetic patients are prone to nosocomial infections, and tight glycaemic control can improve the associated morbidity and mortality. Post-operative infections cause unfavorable consequences in terms of patients' suffering and financial burden in the health care setting. However, strict post-operative glycaemic control has not been widely adopted due to lack of strong evidence for significant cost-effectiveness. Meanwhile, the possibility and consequence of hypoglycaemia needs to be considered. A prospective observational study was performed in a local hospital. The first part was a surveillance of the extent of post-operative hyperglycaemia in all target cases. Local practice for control of post-operative hyperglycaemia was analyzed. The second part was an observational study. The impact of post-operative hyperglycaemia was assessed. The end point was in-hospital post-operative infection. The relationship between postoperative hyperglycaemia and post-operative infection was determined. Cardiac surgery patients were chosen because of the well documented poor prognosis of DM in these cases; moreover, surgery or critically ill status is a stress condition that can induce hyperglycaemia, hence it is related to infections. Post-operative infections in this study included pneumonia/ blood-stream infection, urinary tract infection, and surgical site infection. SPSS 15.0 was used for data analysis. The level of significance (a) was set at 0.05. The confidence interval (CI) was set at 95 %. ANOVA and ANCOVA were used to analyze the glycaemic data. Chi-square tests - Fisher's Exact Test were used to test for relationship between Post-operative Infections and selected variables (Post-operative Hyperglycaemia, 3BG Range, DM Status, and Treatment Status). The American College of Endocrinology position statement has recommended postoperative blood glucose (BG) control should be maintained at or below 6.1 mmol/L for patients needing intensive care. In this study, post-operative hyperglycaemia from Day 0 to Day 2 was observed. All the 3-day BG values (average BG level from post-operative Day 0 to Day 2) (3BG) obtained were greater than 6.1 mmol/L. The extent of post-operative hyperglycaemia was substantial and alarming, while the glycaemic control in the ward was sub-optimal. Although the proposed relationship between post-operative hyperglycaemia and postoperative infection was found to be statistically non-significant, the concept of achieving post-operative euglycaemia remains relevant. Both ICU and the ward focused more on the known DM cases. The post-operative infected cases all had an unknown DM history and the elevated risks in these cases may result from lack of necessary post-operative glycaemic monitoring. In order to offer a better glycaemic control, it may be appropriate that not only the DM, but all post-operative cases should receive glycaemic monitoring. In addition, glycaemic management for the metabolic syndrome (MS) cases, especially for those containing the DM component, should not be overlooked. Although the target range of glycaemic control was controversial, the need of glycaemic treatment was obvious. Post-operative hyperglycaemia should be corrected promptly once detected. Clinical practice should not postpone or ignore necessary post-operative glycaemic treatment until the BG level reaches 10.1 mmol/L. Moreover, treatment should be sufficiently prescribed so as to control post-operative hyperglycaemia optimally to a range locally accepted. Better and tighter post-operative glycaemic control was observed in the ICU. Such discrepancy between ICU and the ward is due to the life-support facilities and for realtime BG monitoring in the ICU. Hence, the risk of hypoglycaemia could be minimized. However, the applicability of tight glycaemic control outside the ICU seems unrealistic in the local clinical setting due to the limited resources and manpower. This study aimed to provide evidence to advocate for an optimal post-operative glycaemic control and to strive for reducing untreated and uncontrolled post-operative hyperglycaemia in clinical setting.

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