Stress-induced hyperglycemia as a risk factor for surgical-site infection in nondiabetic orthopedic trauma patients admitted to the intensive care unit

J Orthop Trauma. 2013 Jan;27(1):16-21. doi: 10.1097/BOT.0b013e31825d60e5.


Objectives: The aim of this study was to evaluate the association between stress-induced hyperglycemia and infectious complications in nondiabetic orthopedic trauma patients admitted to the intensive care unit (ICU).

Design: : This study was a retrospective review.

Setting: The study was conducted at an academic level-1 trauma center.

Patients: One hundred and eighty-seven consecutive trauma patients with isolated orthopedic injuries were studied.

Intervention: : Blood glucose values during initial hospitalization were evaluated. The admission blood glucose (BG) and hyperglycemic index (HGI) were determined for each patient.

Main outcome measures: Perioperative infectious complications: pneumonia, urinary tract infection (UTI), surgical-site infection (SSI), sepsis were the outcome measures.

Results: An average of 21.5 BG values was obtained for each patient. The mean ICU and hospital length of stay was 4.0 ± 4.9 and 10.0 ± 8.1 days, respectively. Infections were recorded in 43 of 187 patients (23.0%) and SSIs specifically documented in 16 patients (8.6%). Open fractures were not associated with SSI (8/83, 9.6% vs. 8/104, 7.7%). There was no difference in admission BG or HGI and infection. However, there was a significant difference in HGI when considering SSI alone (2.1 ± 1.7 vs. 1.2 ± 1.1). Patients with an SSI received a greater amount of blood transfusions (14.9 ± 12.1 vs. 4.9 ± 7.6). No patient was diagnosed with a separate infection (ie, pneumonia, UTI, bacteremia) before SSI. There was no significant difference in injury severity score among patients with an SSI (11.1 ± 4.0 vs. 9.6 ± 3.0). Multivariable regression testing with HGI as a continuous variable demonstrated a significant relationship (odds ratio: 1.8, 95% confidence interval: 1.3-2.5) with SSI after adjusting for blood transfusions (odds ratio: 1.1, 95% confidence interval: 1.1-1.2).

Conclusions: : Stress-induced hyperglycemia demonstrated a significant independent association with SSIs in nondiabetic orthopedic trauma patients who were admitted to the ICU.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Female
  • Fractures, Bone / surgery*
  • Humans
  • Hyperglycemia / complications*
  • Hyperglycemia / etiology
  • Intensive Care Units
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Stress, Physiological*
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / etiology*