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March 2011

What Should the Targeted Range of Blood Glucose Levels Be to Reduce the Incidence of Surgical Site Infection Following General Surgery?

Author Affiliations

Author Affiliations: Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan.

Arch Surg. 2011;146(3):368-369. doi:10.1001/archsurg.2011.16

We read with great interest the article by Ata et al.1 The authors concluded that postoperative hyperglycemia may be the most important risk factor for surgical site infection (SSI) and that aggressive early postoperative glycemic control (ie, a glucose level of <140 mg/dL [to convert to millimoles per liter, multiply by 0.0555]) should reduce the incidence of SSI. Perioperative hyperglycemia in critically ill surgical patients is the main risk factor for the development of postoperative infection, which is a common, and often costly, surgical complication.2 Results from our own prospective randomized clinical trials suggest that tight perioperative glycemic control using an artificial endocrine pancreas (with a targeted range of blood glucose levels of 80-110 mg/dL) in either hepatectomized3 or pancreatectomized4 patients significantly reduces the incidence of SSI compared with conventional insulin therapy (with a targeted range of blood glucose levels of 150-200 mg/dL). On the basis of these findings, tight perioperative glycemic control may be a key factor in reducing the incidence of postoperative infections, including SSI, and thus in reducing morbidity and mortality after general surgery.

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