Marc kenz kChan 8SN IV8

ostoperat|ve n|gh 8|ood

Sugar Appears to 8e
Assoc|ated W|th Surg|ca|
S|te Infect|on

5cienceuoi/y {lon 25 2011) niqh
b/ood q/ucose /eve/s ofter surqery moy be on
importont risk foctor for infection ot the
surqico/ site in potients hovinq qenero/ surqery
occordinq to o report in the 5eptember issue of
4rchives of 5urqery one of the l4M4/4rchives
journo/s
Surg|ca| s|te |nfect|on accounts for
14 percent to 17 percent of hosp|ta|
acqu|red |nfect|ons mak|ng |t the th|rd
most common type of |nfect|on acqu|red at
hea|thcare fac|||t|es and the most
common among pat|ents hav|ng surgery
accord|ng to background |nformat|on |n
the art|c|e Stud|es have shown that these
|nfect|ons pro|ong the hosp|ta| |ength of
stay after surgery |ncrease
rehosp|ta||zat|on rates and dramat|ca||y
|ncrease the use of emergency serv|ces and
hea|th care costs the authors wr|te
Ashar Ata M88S Mn and
co||eagues at A|bany Med|ca| Co||ege
A|bany N rev|ewed the med|ca| records
of pat|ents who had genera| or vascu|ar
surgery between Sept 11 2010 and Dec
30 2010 A tota| of 2090 pat|ents were
random|y se|ected from a qua||ty
|mprovement database and then matched
w|th med|ca| records to obta|n |nformat|on
about postoperat|ve g|ucose va|ues 1hese
va|ues were ava||ab|e for 1S61 pat|ents
|nc|ud|ng SS9 who had vascu|ar surgery
226 who had co|orecta| surgery and 776
who had a type of genera| surgery other
than co|orecta|
Cvera|| 742 percent of the
pat|ents deve|oped surg|ca| s|te |nfect|ons
|nc|ud|ng 1411 percent of those who had
co|orecta| surgery 1032 percent who had
vascu|ar surgery and 436 percent of those
who had other genera| surgery
Among genera| surgery pat|ents
factors assoc|ated w|th surg|ca| s|te
|nfect|on |nc|uded age emergency status
phys|ca| status as c|ass|f|ed by the
Amer|can Soc|ety of Anesthes|o|og|sts
t|me |n surgery d|abetes and h|gh
postoperat|ve b|ood g|ucose
(hyperg|ycem|a) nowever after ad[ust|ng
for postoperat|ve b|ood g|ucose |eve| a||
other factors were not s|gn|f|cant
pred|ctors of |nfect|on A subana|ys|s of
co|orecta| surgery pat|ents found that a
postoperat|ve serum g|ucose |eve| h|gher
than 140 m||||grams per dec|||ter was the
on|y s|gn|f|cant pred|ctor of surg|ca| s|te
|nfect|on Among vascu|ar surgery
pat|ents operat|ve t|me and d|abetes were
the on|y s|gn|f|cant pred|ctors of surg|ca|
s|te |nfect|on wh|ch was not assoc|ated
w|th postoperat|ve hyperg|ycem|a
nyperg|ycem|a may |mpa|r the |mmune
system and |nsu||n may have ant|
|nf|ammatory and other ant||nfect|ve
act|v|t|es nowever |t |s poss|b|e that the
accumu|at|on of other r|sk factors for
surg|ca| s|te |nfect|on cause hyperg|ycem|a
rather than v|ce versa hence further
study |s needed the authors note
In conc|us|on we found
postoperat|ve hyperg|ycem|a to be the
most |mportant r|sk factor for surg|ca| s|te
|nfect|on |n genera| and co|orecta| cancer
surgery pat|ents and serum g|ucose |eve|s
h|gher than 110 m||||grams per dec|||ter
were assoc|ated w|th |ncreas|ng|y h|gher
rates of postsurg|ca| |nfect|on they
cont|nue If hyperg|ycem|a |s conf|rmed |n
future prospect|ve stud|es w|th better
postoperat|ve g|ucose data to be an
|ndependent r|sk factor for postsurg|ca|
|nfect|on |n genera| surgery pat|ents th|s
wou|d g|ve surgeons a mod|f|ab|e var|ab|e
to reduce the |nc|dence of postoperat|ve
|nfect|on

Iourna| keference
1 A Ata I Lee S L 8est|e I Desemone S C Sta|n ostoperat|ve nyperg|ycem|a and Surg|ca| S|te Infect|on |n Genera|
Surgery at|ents 4rchives of 5urqery 2011 14S (9) 8S8 DCI 101001]archsurg2011179








































keact|on

ln Lhls [ournal lL was belng menLloned LhaL a sLudy has been made Lo cerLaln paLlenLs
who had undergone surglcal procedure and whlch glucose level has also been sLudled Lo relaLe
some Lhlngs regardlng Lhe occurrence of lnfecLlon Many rlsk facLors could conLrlbuLe Lo
occurrence of posLoperaLlve lnfecLlons Pyperglycemla ls one facLor because lL may lmpalr Lhe
lmmune sysLem ln carlng Lo our posLoperaLlve cllenLs we are well versed wlLh Lhe usual ways
on how Lo care for our paLlenLs 8uL we are only focuslng on llmlLed poLenLlal for developlng
compllcaLlons especlally wlLh lnfecLlons We know how Lo care asepLlcally wlLh Lhe surglcal slLe
and we admlnlsLer anLlbacLerlal ln order Lo prevenL Lhe lnfecLlon Lo occur 8uL Lhese Lhlngs
accordlng Lo sLudles would noL be enough We musL have Lo Lake ln conslderaLlon also oLher
aspecLs llke Lhe blood glucose level of Lhe paLlenL as Lo whaL was dlscovered ln sLudles LhaL
hyperglycemla could be Lhe mosL lmporLanL rlsk facLor wlLh regards Lo developlng surglcal slLe
lnfecLlon ln general and colorecLal cancer surgery paLlenLs
When we refer Lo posLoperaLlve care lL ls Lhe Llme LhaL Lhe paLlenL ls LransporLed back
Lo Lhe surglcal unlL from Lhe recovery room or Lhe dlscharge from Lhe hosplLal unLll followup
care lL ls ln our responslblllLy as nurses Lo malnLaln adequaLe body funcLlons allevlaLe paln and
dlscomforL belng felL aL Lhe slLe of lnclslon resLore homeosLasls and mosL especlally Lo prevenL
posLoperaLlve compllcaLlons by ensurlng adequaLe healLh Leachlng 8uL someLlmes we Lend Lo
concenLraLe only on one area LhaL we forgeL Lo assess oLher Lhlngs LhaL could conLrlbuLe Lo Lhe
condlLlon of Lhe paLlenL elLher ln promoLlng fasL recovery or ln prevenLlng Lhe occurrence of
any lnfecLlon lL ls a common Lhlng especlally wlLh Lhose paLlenLs aL rlsk Lo develop
compllcaLlon afLer surgery elLher due Lo Lhelr body's level of funcLlonlng or maybe due Lo some
oLher facLors 1hls conLrlbuLes Lo Lhe longer sLay of Lhe paLlenL Lo Lhe hosplLal as Lo whaL sLudy
shows
1hls [ournal ls really of greaL help for lL would remlnd us nurses belng Lhe dlrecL
care provlder Lo our paLlenL Lo be more senslLlve wlLh Lhe needs and Lhe facLors LhaL could
aggravaLe or lessen Lhe rlsk of developlng lnfecLlons of our cllenLs
Nurs|ng theory

Cne nurslng Lheory LhaL could be relaLed Lo Lhls Loplc would be Lhe Lheory of vlrglnla
Penderson abouL asslsLlng Lhe lndlvldual ln performance of acLlvlLles conLrlbuLlng Lo healLh or
lLs recovery She also lnLroduced abouL Lhe 14 8aslc needs of CllenLs and lL ls lncluded ln here
Lhe avoldance of dangers ln Lhe envlronmenL lL ls a responslblllLy of Lhe nurse Lo prevenL Lhe
developmenL of any compllcaLlon especlally of posLoperaLlve lnfecLlon ln slLuaLlons where Lhe
paLlenL cannoL meeL hls baslc needs Lhe nurse serves as a helper Lo accompllsh Lhem Slnce
Lhese needs are needed Lo achleve healLh Lhe nurse focuses her aLLenLlon ln asslsLlng Lhe
paLlenL meeL Lhese needs so as Lo regaln lndependence as qulckly as posslble from Lhe prevlous
procedure done
lL was dlscussed ln Lhls arLlcle Lhe rlsk for lnfecLlon belng caused by an lncrease ln
glucose level and Lhls Lheory lncludes Lhe avoldance of danger So malnLalnlng Lhe rlghL level of
glucose could prevenL Lhe posslblllLy of developlng posLoperaLlve lnfecLlon whlch could also
promoLe a fasL recovery of Lhe paLlenL