Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials
BackgroundIncreased risk of surgical site infections (SSIs) caused by hyperglycemia makes it necessary to follow perioperative glucose lowering strategies to reduce postoperative complications. A meta-analysis was conducted to understand the efficacy of intensive vs. conventional blood glucose lower...
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| Format: | Article |
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.855409/full |
| _version_ | 1818204636940599296 |
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| author | Jing Lai Qihong Li Ying He Shiyue Zou Xiaodong Bai Sanjay Rastogi |
| author_facet | Jing Lai Qihong Li Ying He Shiyue Zou Xiaodong Bai Sanjay Rastogi |
| author_sort | Jing Lai |
| collection | DOAJ |
| description | BackgroundIncreased risk of surgical site infections (SSIs) caused by hyperglycemia makes it necessary to follow perioperative glucose lowering strategies to reduce postoperative complications. A meta-analysis was conducted to understand the efficacy of intensive vs. conventional blood glucose lowering regimens on the incidence of SSIs and hypoglycemia from various randomized controlled studies (RCTs).Materials and MethodsA systematic literature review was conducted using MEDLINE and Central databases for RCTs that involved intensive (lower blood glucose target levels) vs. conventional (higher blood glucose target levels) strategies in patients undergoing various types of surgeries. The primary outcomes were SSIs or postoperative wound infections. Hypoglycemia and mortality outcomes were also studied. A random-effects model was used to calculate the pooled risk ratio (RR), and subgroup analyses were performed.ResultsA total of 29 RCTs were included in the meta-analysis with the information from 14,126 patients. A reduction in overall incidence of SSIs was found (RR 0.63, 0.50–0.80, p = 0.0002, I2= 56%). Subgroup analyses showed that intensive insulin regimens decreased the risk of SSIs in patients with diabetes, in cardiac and abdominal surgical procedures, and during the intraoperative and postoperative phases of surgery. However, the risk of hypoglycemia and mortality was increased in the intensive group compared to the conventional group.ConclusionThe results of the meta-analysis provide support for the use of intensive insulin regimens during the perioperative phase for decreasing the incidence of SSIs in certain patient populations and surgical categories. |
| first_indexed | 2024-12-12T03:44:24Z |
| format | Article |
| id | doaj.art-af48f1e305b54c17bbd5a54699d71591 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-12T03:44:24Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-af48f1e305b54c17bbd5a54699d715912022-12-22T00:39:36ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-03-01910.3389/fsurg.2022.855409855409Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical TrialsJing Lai0Qihong Li1Ying He2Shiyue Zou3Xiaodong Bai4Sanjay Rastogi5Department of Nursing, The First People's Hospital of Longquanyi District, Chengdu, ChinaDepartment of Internal Medicine, Yantai Qishan Hospital, Yantai, ChinaDepartment of Science and Teaching, The First People's Hospital of Longquanyi District, Chengdu, ChinaDepartment of Endocrinology, The First People's Hospital of Longquanyi District, Chengdu, ChinaDepartment of Outpatient, China Medical University, Shenyang, ChinaDepartment of OMFS, Regional Dental College, Guwahati, IndiaBackgroundIncreased risk of surgical site infections (SSIs) caused by hyperglycemia makes it necessary to follow perioperative glucose lowering strategies to reduce postoperative complications. A meta-analysis was conducted to understand the efficacy of intensive vs. conventional blood glucose lowering regimens on the incidence of SSIs and hypoglycemia from various randomized controlled studies (RCTs).Materials and MethodsA systematic literature review was conducted using MEDLINE and Central databases for RCTs that involved intensive (lower blood glucose target levels) vs. conventional (higher blood glucose target levels) strategies in patients undergoing various types of surgeries. The primary outcomes were SSIs or postoperative wound infections. Hypoglycemia and mortality outcomes were also studied. A random-effects model was used to calculate the pooled risk ratio (RR), and subgroup analyses were performed.ResultsA total of 29 RCTs were included in the meta-analysis with the information from 14,126 patients. A reduction in overall incidence of SSIs was found (RR 0.63, 0.50–0.80, p = 0.0002, I2= 56%). Subgroup analyses showed that intensive insulin regimens decreased the risk of SSIs in patients with diabetes, in cardiac and abdominal surgical procedures, and during the intraoperative and postoperative phases of surgery. However, the risk of hypoglycemia and mortality was increased in the intensive group compared to the conventional group.ConclusionThe results of the meta-analysis provide support for the use of intensive insulin regimens during the perioperative phase for decreasing the incidence of SSIs in certain patient populations and surgical categories.https://www.frontiersin.org/articles/10.3389/fsurg.2022.855409/fullsurgical site infectionsglycemic controllaparoscopic surgeriesneurosurgeriesgeneral surgery |
| spellingShingle | Jing Lai Qihong Li Ying He Shiyue Zou Xiaodong Bai Sanjay Rastogi Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials Frontiers in Surgery surgical site infections glycemic control laparoscopic surgeries neurosurgeries general surgery |
| title | Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials |
| title_full | Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials |
| title_fullStr | Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials |
| title_full_unstemmed | Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials |
| title_short | Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials |
| title_sort | glycemic control regimens in the prevention of surgical site infections a meta analysis of randomized clinical trials |
| topic | surgical site infections glycemic control laparoscopic surgeries neurosurgeries general surgery |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.855409/full |
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