The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: A systematic review

Objective: A systematic review of the effects of tight glycemic control with a continuous insulin infusion to achieve blood glucose levels <= 200 mg/dL on surgical site infections and readmission rates in adult patients with diabetes after cardiac surgery. Methods: A quantitative systematic review of the literature. Databases, including PubMed, CINAHL, EMBASE, and CENTRAL, were searched for relevant studies from database inception through August 2014. Randomized and quasi-experimental studies were included. Results: A meta-analysis of ten studies demonstrated that glycemic control with a continuous insulin infusion to achieve blood glucose levels <= 200 mg/dL significantly reduced surgical site infection rates (odds ratio 0.35, 95% confidence interval 0.25-0.49; Z = 6.0, P < 0.00001) compared with standard diabetes management. Conclusions: Maintaining blood glucose levels <= 200 mg/dL with a continuous insulin infusion in all stages of the perioperative period in cardiac surgery patients with diabetes can reduce the incidence of surgical site infections. (c) 2015 Elsevier Inc. All rights reserved.