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Surgical site infection
Wound healing
Wound infection

Tight glycaemic control and surgical site infections post cardiac surgery: a systematic review

01 December 2021
Education

Abstract

Objective:

Surgical site infection (SSI) is one of the most serious potential complications post cardiac surgery among patients with diabetes and has a number of adverse health outcomes. The literature shows discrepancies regarding the effect of different glycaemic control protocols on reducing adverse health outcomes including SSIs. The aim of this study was to conduct a systematic review that investigated the effect of the optimal range of tight glycaemic control protocols using a continuous insulin infusion on reducing the incidence of SSIs in adult patients with diabetes undergoing cardiac surgery.

Method:

A systematic review was conducted following the PRISMA statement and guidelines. Search terms were used to identify research studies published between 2000 and 2019 across five key databases, including CINAHL, Medline, PubMed, Cochrane Database and Google Scholar.

Results:

A total of 12 studies met the review inclusion criteria. The reviewed literature tended to support the implementation of a tight glycaemic control protocol, particularly in the postoperative phase, that demonstrated fewer potential complications associated with cardiac surgery. On the other hand, the literature also supported the application of a moderate glycaemic control protocol in the intraoperative phase to obtain better glycaemic stability with fewer potential complications among those patients with diabetes undergoing cardiac surgery.

Conclusion:

This analysis concludes that tight glycaemic control is more effective than moderate glycaemic control intraoperatively in terms of glycaemic stability among patients with diabetes undergoing cardiac surgery. Results also emphasised the importance of time-based protocol implementation to ensure better health outcomes and better quality of care for patients.

Diabetes is considered one of the major risks of surgical site infections (SSIs).1 Moreover, in patients undergoing cardiac surgery, diabetes is identified as an independent risk factor associated with SSIs.1,2,3,4,5,6,7,8 Previous studies suggested a link between poor glycaemic control and adverse outcomes in patients with diabetes undergoing coronary artery bypass grafting (CABG) surgery, including a higher rate of SSIs.9,10,11 However, the estimated prevalence of diabetes among patients undergoing cardiac surgery was 20.1–48.0%.12,13,14,15

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cardiac surgery
conventional glycaemic control
diabetes
glycaemic control
insulin
insulin infusion
surgical site infections
systematic review
tight glycaemic control
wound
wound care
wound healing
wounds