Intraoperative blood sugar control critical for reducing infections in diabetics undergoing CABG: Study
Jordan: A recent study has suggested that post coronary artery bypass graft (CABG) surgery nurses should consider the glycemic control and glycemic stability approach to minimize adverse surgical outcomes. Also, the researchers note that healthcare providers should carefully consider diabetes patients who have undergone bypass surgery and are at risk of developing postoperative surgical site infections (SSIs). The study results were published in the journal Heliyon on December 01, 2021.
Poor blood sugar control in diabetes patients undergoing CABG surgery has been related to infectious complications, specifically SSIs that are linked with adverse health surgical outcomes.
Issa M. Hweidi, Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Irbid, Jordan, and colleagues aimed to examine the effect of two different intraoperative glycemic control protocols, tight and conventional, on thirty-day postoperative SSI rates in diabetes patients undergoing CABG surgery.
For this purpose, the researchers employed a randomized controlled trial (RCT) design, with a convenience sample of 144 adult patients who were to undergo CABG surgery. The study was set up in a main referral heart institute in Amman, Jordan.
The participants were randomly assigned to either the tight glycemic control group (n = 72), or the conventional glycemic control group (n = 72). Participants in the tight glycemic control group were maintained at an intraoperative blood glucose level of 110–149 mg/dl via continuous intravenous insulin infusion. In the conventional glycemic control group, they were maintained at an intraoperative blood glucose level of 150–180 mg/dl via continuous intravenous insulin infusion. Independent blinded physicians evaluated and compared postoperative SSIs among both groups.
Key findings include:
- There was a small portion of the study participants in the tight glycemic control group had SSIs compared to the conventional glycemic control group.
- As for the tight group, the highest percentage among the infection types was DSWI followed by SHWI and DHWI among the study participants.
- No SSWI was reported among participants within this group of glycemic control intervention.
- There was no statistically significant difference between the two glycemic control interventions among study groups.
- Intraoperative tight glycemic control did not reduce thirty-day postoperative SSIs among the participants.
The principal findings were that there was no statistically significant difference between the two treatment groups in terms of SSI rates and their potential adverse surgical outcomes.
"Our results show that the use of tight glycemic control during the intraoperative period can be safely achieved through the judicious implementation of the protocol," the researchers wrote. "It is very important to identify patients who were more likely to develop postoperative SSIs."
"Therefore, when providing care for at-risk patients, nurses should consider the glycemic stability and glycemic control approach to minimize the occurrence of adverse surgical outcomes post-CABG surgery, more specifically SSIs," they concluded.
Reference:
The study titled, "The effect of intraoperative glycemic control on surgical site infections among diabetic patients undergoing coronary artery bypass graft (CABG) surgery," was published in the journal Heliyon.
