What’s New in the Patient Safety World
December
2008 More on Preventing SSI’s
More on Preventing
Surgical Site Infections (SSI’s)
Last month (November 2008 What’s New in the Patient Safety
World “Preventing
Surgical Site Infections: New Resources”) we noted some of the
evidence-based recommendations for preventing surgical site infections (SSI’s).
A couple of the recommendations that have been based on less rigorous evidence,
smoking cessation and avoidance of hyperglycemia, have just received more
backing in studies just published.
Lindstrom and
colleagues (Lindstrom
2008) reported the results of a randomized controlled trial on the impact
of smoking cessation begun within 4 weeks of elective surgery on surgical
complication rates. The found almost a 50% reduction in total complication rate
for patients in the intervention (smoking cessation) arm. The study, however,
was limited by its small size (they had difficulty recruiting patients who
might be randomized to the smoking cessation arm). Looking at just SSI’s,
though fewer wound infections occurred in the intervention group, the numbers
were far too small to meet statistical significance. Nevertheless, the study is
important in lending weight to smoking cessation preoperatively. Whereas most
prior studies that showed a benefit on postoperative complications began
smoking cessation 6-8 weeks prior to surgery, this study demonstrates that there
is a benefit even when smoking cessation is begun as late as 4 weeks prior to
elective surgery.
Ramos and colleagues
(Ramos
2008) published a study strengthening the correlation between perioperative
hyperglycemia and postoperative infections (including SSI’s), independent of
preoperative blood glucose level or diabetic status. Using data from a
risk-adjusted outcomes database from the National Surgical Quality Improvement
Project, they showed that for each 40 mg/dl increase in serum glucose the risk
of postoperative infection rose 30%. Postoperative hyperglycemia also had a
significant adverse effect on length of stay. Caution: this was not a
randomized controlled trial to show that treatment to avoid perioperative
hyperglycemia results in fewer SSI’s or better outcomes but it further
strengthens the association between hyperglycemia and postoperative infections.
Together, these two
studies strengthen the evidence for those two interventions in the guidelines
for preventing SSI’s that we talked about last month.
References:
Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT,
Zinner M, Rogers SO. Relationship of Perioperative
Hyperglycemia and Postoperative Infections in Patients Who Undergo General and
Vascular Surgery. Ann Surg 2008; 248(4):585-591
Lindstrom D, Azodi OS, Wladis A, Tonnesen H, Linder S, Nasell H, Ponzer S, Adami J. Effects of a Perioperative Smoking Cessation Intervention on Postoperative Complications: A Randomized Trial. Annals of Surgery. 2008; 248(5):739-745 http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200811000-00008.htm;jsessionid=J2LL93fxpLQhQMXlrBMyG85SWpcX3xy1s3LPbxj5bF6S49HWfGhQ!976670012!181195629!8091!-1
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