Perioperative Glycemic Control and the Effect on Surgical Site Infections in Diabetic Patients Undergoing Foot and Ankle Surgery

Foot Ankle Spec. 2016 Feb;9(1):24-30. doi: 10.1177/1938640015593077. Epub 2015 Jun 30.


Introduction: Diabetes mellitus is one of the leading causes of hyperglycemia in the perioperative setting. Hyperglycemia has been shown to cause increased risk of surgical site infections (SSIs) in multiple surgical specialties, but to our knowledge it has not been investigated for orthopaedic foot and ankle surgery. The aim of this study was to determine if hyperglycemia increased the rate of SSI in elective, diabetic patients that required perioperative hospitalization.

Methods: A total of 348 consecutive inpatients after foot and ankle surgery were retrospectively evaluated. Patients who had a random serum glucose ≥200 mg/dL during the admission (Group 1) were compared to patients whose serum glucose never exceeded 200 mg/dL (Group 2).

Results: Our 2 groups were similar with regard to age, gender, and body mass index. Twenty-one of 176 patients (11.9%) whose serum glucose was ≥200 mg/dL during the admission developed an SSI as compared to 9 of 172 patients (5.2%) whose serum glucose remained <200 mg/dL (odds ratio = 2.45; 95% confidence interval = 1.09-5.52;, P = .03).

Discussion: Perioperative hyperglycemia ≥200 mg/dL is associated with increased rates of SSI after foot and ankle surgery. Communication with medical consultants is paramount in an effort to improve perioperative glycemic management and reduce the rate of SSI.

Levels of evidence: Prognostic, Level III: Case Control.

Keywords: diabetes; glucose; hyperglycemia; infection; inpatient; operative.

MeSH terms

  • Blood Glucose / analysis
  • Diabetic Foot / surgery*
  • Female
  • Humans
  • Hyperglycemia / complications*
  • Hyperglycemia / prevention & control*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Surgical Wound Infection / etiology*
  • Surgical Wound Infection / prevention & control*


  • Blood Glucose