Postoperative glucose control : decreasing incidence of cardiothoracic surgical site infections in diabetic patients

Abstract

Overview: Diabetes is a condition where blood sugar levels are too high due to incorrect and insufficient insulin use and production. Research shows a significant relationship between diabetes and surgical site infection for cardiothoracic surgeries. The importance of postoperative glucose control on reducing the incidence of cardiothoracic surgical site infections amongst diabetic patients is reviewed. The research question: Amongst diabetic patients undergoing cardiothoracic surgery, does postoperative glucose control decrease their risk of surgical site infection when compared to no glucose control? PICO elements: Population (P): diabetic patients undergoing cardiothoracic surgery; Intervention (I): postoperative glucose control; Comparison (C): no glucose control; Outcome (O): decreased risk of surgical site infection Inclusion and exclusion criteria: The chosen studies focused on diabetic patients undergoing cardiothoracic surgery receiving postoperative glucose control treatment regimens and surgical site infections. Other surgical outcomes and non-cardiac surgery studies were excluded. Search outcome: This was presented via PRISMA (2009) checklists and comprised of six key studies, one systematic review, one randomized controlled trial and four cohort studies. Method: Keywords and synonyms were used alongside Boolean operators and limiters for selection of articles. The search was carried out across the online library, mainly PubMed, Ageline (EBSCO) and Nursing & Allied Health Database (ProQuest). The obtained studies were appraised with the use of CASP tools. Results: Most of the studies derived that postoperative glucose control was beneficial in reducing the incidence of cardiothoracic surgical site infections amongst diabetic patients, however, statistical significance was not always present. Conclusion: Although the reviewed studies presented a beneficial relationship between postoperative glucose control and the incidence of cardiothoracic surgical site infections in diabetic patients, no definite conclusion could be presented due to certain studies not reaching statistical significance. Thus, further research is required to answer the PICO question meticulously. Implications and recommendations: Establishing practice protocols in health-care settings would ensure optimal patient care and outcomes. Continuous professional development is essential to ensure optimal patient care. Effective management of the administration and maintenance of postoperative glucose control, monitored by a specialist team would continue to establish patient safety. Further research on the subject with larger population samples would prove beneficial.