Glycemic Control and Reduction of Deep Sternal Wound Infection Rates: A Multidisciplinary Approach | Cardiothoracic Surgery | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
van den Berghe  GWouters  PWeekers  F  et al.  Intensive insulin therapy in the critically ill patients.  N Engl J Med 2001;345 (19) 1359- 1367PubMedGoogle ScholarCrossref
Furnary  APZerr  KJGrunkemeier  GLHeller  AC Hyperglycemia: a predictor of mortality following CABG in diabetics [abstract 3117].  Circulation 1999;100 (18) ((suppl 1)) I-591Google Scholar
Furnary  APChaugle  HZerr  KJGrunkemeier  GL Postoperative hyperglycemia prolongs length of stay in diabetic CABG patients [abstract 2703].  Circulation 2000;102 (18) ((suppl 2)) II-556Google Scholar
Furnary  APGao  GGrunkemeier  GL  et al.  Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting.  J Thorac Cardiovasc Surg 2003;125 (5) 1007- 1021PubMedGoogle ScholarCrossref
Furnary  APZerr  KJGrunkemeier  GLStarr  A Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.  Ann Thorac Surg 1999;67 (2) 352- 362PubMedGoogle ScholarCrossref
Zerr  KJFurnary  APGrunkemeier  GLBookin  SKanhere  VStarr  A Glucose control lowers the risk of wound infection in diabetics after open heart operations.  Ann Thorac Surg 1997;63 (2) 356- 361PubMedGoogle ScholarCrossref
Doenst  TWijeysundera  DKarkouti  K  et al.  Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery.  J Thorac Cardiovasc Surg 2005;130 (4) 1144PubMedGoogle Scholar
Garber  AJMoghissi  ESBransome  ED  Jr  et al. American College of Endocrinology Task Force on Inpatient Diabetes Metabolic Control, American College of Endocrinology position statement on inpatient diabetes and metabolic control.  Endocr Pract 2004;10 (1) 77- 82PubMedGoogle ScholarCrossref
May 1, 2008

Glycemic Control and Reduction of Deep Sternal Wound Infection Rates: A Multidisciplinary Approach

Author Affiliations

Author Affiliations: Division of Cardiothoracic Surgery, Maine Medical Center, Portland (Dr Kramer, Mr Groom, and Mss Weldner, Gallant, and Heyl); and the Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire (Mr Groom, Dr Knapp, and Ms Arnold).

Arch Surg. 2008;143(5):451-456. doi:10.1001/archsurg.143.5.451

Objective  To demonstrate the multidisciplinary interactions and tools required to effect changes in the processes of care to achieve tight glycemic control (TGC) and reduce deep sternal wound infection (DSWI) rates in patients undergoing cardiac surgery.

Design  A retrospective cohort analysis comparing the rate of DSWI before and after implementing a multidisciplinary TGC initiative.

Setting  A cardiac surgical program in a tertiary care community hospital in New England.

Patients  A total of 3065 consecutive adult patients undergoing cardiac surgery who were operated on between January 1, 2004, and December 31, 2006.

Interventions  Evidence demonstrating the relationship between hyperglycemia and DSWI was presented to the multidisciplinary group caring for patients undergoing cardiac surgery. In addition, special emphasis was placed on nursing feedback and in-service training. A cumbersome glycemic management text protocol was replaced with a novel color-coded bedside tool (nomogram) to guide the bedside management of hyperglycemia. Subsequently, an algorithm for the transition to a home regimen was developed, which further improved standardization of care and ease of management.

Main Outcome Measures  Hourly blood glucose level monitoring and the incidence of DSWI.

Results  Eighteen months after the new program was initiated, the DSWI rate decreased by more than 60% from 2.6% to 1.0%, when compared with the preceding 18 months (P < .001).

Conclusion  A TGC program using a novel tool in a multidisciplinary setting was successfully and safely established, resulting in sustained improvement in the DSWI rate.