Ata and colleagues1 prematurely conclude that “[a]ggressive early postoperative glycemic control should reduce the incidence of SSI.” It does not automatically follow that interventions (particularly with long-acting insulins) to reduce the incidence of hyperglycemia will be beneficial for the patient.
It is concerning that the authors make no mention of the method or site (eg, venous, arterial, or capillary) of serum glucose measurement. Were glucose measurements obtained using an accurate central laboratory device or a portable glucose meter2 (which may be dangerously inaccurate, especially in the hypoglycemic range)? Data are not presented on how many patients without known diabetes, impaired glucose tolerance, or impaired fasting glucose were hyperglycemic and included in the study. This is important given that 40% of patients with diabetes mellitus are unaware of its presence3 and that hyperglycemia in critically ill patients without known diabetes may portend worsened outcomes.
Pitkin AD, Coursin D, Rice MJ. Hyperglycemia and Surgical Site Infection: Not Ready for Prime Time. Arch Surg. 2011;146(3):369-370. doi:10.1001/archsurg.2011.18