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Peri-operative glucose control and development of surgical wound infections in patients undergoing coronary artery bypass graft
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
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2005 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 61, no 3, 201-212 p.Article in journal (Refereed) Published
Abstract [en]

Elevated blood glucose following coronary artery bypass graft (CABG) is associated with an increased risk of surgical wound infection (SWI). It is unclear whether hyperglycaemia, the diabetic state, the longstanding vascular effects of diabetes, or the systematic inflammatory response confers the increased vulnerability to SWI. This study was designed to examine the significance of postoperative blood glucose control as a risk factor for SWI after vein graft harvesting on the leg and sternotomy. Patients with and without diabetes had a CABG within 60 days to be eligible. The present study was part of a larger protocol investigating SWI following CABG in a total of 374 patients. Potential risk factors, duration of diabetes, pre-operative glycated haemoglobin (HbA1c) and presence of long-term complications were recorded. All patient records were reviewed retrospectively to record 10% glucose infusions during the operation, and blood glucose concentrations and insulin therapy on postoperative days 0, 1 and 2. Patients were contacted by telephone 30 and 60 days after surgery and interviewed in accordance with a questionnaire about symptoms and signs of wound infection. In the present study, it was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia. However, in the subgroup of patients without a pre-operative diagnosis of diabetes, increased blood glucose concentrations during postoperative days 0, 1 and 2 was associated with an increased risk of mediastinitis.

Place, publisher, year, edition, pages
2005. Vol. 61, no 3, 201-212 p.
National Category
Surgery Nursing
Identifiers
URN: urn:nbn:se:uu:diva-94922DOI: 10.1016/j.jhin.2005.02.015PubMedID: 16039014OAI: oai:DiVA.org:uu-94922DiVA: diva2:168944
Projects
Coronary artery bypass graft; Surgical wound infection; Blood glucose; Postoperative
Available from: 2006-10-06 Created: 2006-10-06 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Wound Infection Following Coronary Artery Bypass Graft Surgery: Risk Factors and the Experiences of Patients
Open this publication in new window or tab >>Wound Infection Following Coronary Artery Bypass Graft Surgery: Risk Factors and the Experiences of Patients
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered.

Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life.

SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 177
Keyword
Caring sciences, coronary artery bypass graft, surgical wound infection, infection control, risk factor, blood glucose, postoperative, Saphenous vein harvesting, wound evaluation scale, mediastinitis, psychology, quality of life, Vårdvetenskap
Identifiers
urn:nbn:se:uu:diva-7168 (URN)91-554-6669-9 (ISBN)
Public defence
2006-10-27, Auditoriet, Museum Gustavianum, Akademigatan 3, 753 10 Uppsala, 13:15
Opponent
Supervisors
Available from: 2006-10-06 Created: 2006-10-06Bibliographically approved

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Swenne, Christine LeoBorowiec, JanCarlsson, Marianne

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