The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: A systematic review

Abstract Objective A systematic review of the effects of tight glycemic control with a continuous insulin infusion to achieve blood glucose levels ≤ 200 mg/dL on surgical site infections and readmission rates in adult patients with diabetes after cardiac surgery. Methods A quantitative systematic re...

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Published in:Heart & lung 2015-09, Vol.44 (5), p.430-440
Main Authors: Boreland, Lyn, MSN, RN, FNP-BC, DNPc, Scott-Hudson, Marcia, MSN, RN, FNP-BC, DNPc, Hetherington, Kathy, MSN, RN, FNP-BC, DNPc, Frussinetty, Antoinette, MSN, RN, FNP-BC, DNPc, Slyer, Jason T., DNP, RN, FNP-BC, CHFN
Format: Article
Language:English
Subjects:
Adult
Blood Glucose - metabolism
Cardiac surgery
Cardiac Surgical Procedures
Cardiovascular
Critical Care
Diabetes
Diabetes Mellitus - blood
Diabetes Mellitus - drug therapy
Glucose
Glycemic control
Heart surgery
Humans
Hypoglycemic Agents - administration & dosage
Insulin
Insulin - administration & dosage
Insulin Infusion Systems
Meta-analysis
Odds Ratio
Patient Readmission - statistics & numerical data
Pulmonary/Respiratory
Side effects
Surgical site infection
Surgical Wound Infection - prevention & control
Systematic review
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Summary:Abstract Objective A systematic review of the effects of tight glycemic control with a continuous insulin infusion to achieve blood glucose levels ≤ 200 mg/dL on surgical site infections and readmission rates in adult patients with diabetes after cardiac surgery. Methods A quantitative systematic review of the literature. Databases, including PubMed, CINAHL, EMBASE, and CENTRAL, were searched for relevant studies from database inception through August 2014. Randomized and quasi-experimental studies were included. Results A meta-analysis of ten studies demonstrated that glycemic control with a continuous insulin infusion to achieve blood glucose levels ≤ 200 mg/dL significantly reduced surgical site infection rates (odds ratio 0.35, 95% confidence interval 0.25-0.49; Z = 6.0, P < 0.00001) compared with standard diabetes management. Conclusions Maintaining blood glucose levels ≤ 200 mg/dL with a continuous insulin infusion in all stages of the perioperative period in cardiac surgery patients with diabetes can reduce the incidence of surgical site infections.
ISSN:0147-9563
1527-3288
DOI:10.1016/j.hrtlng.2015.06.004