The impact of poor post-operative glucose control on neurosurgical surgical site infections (SSI)


      • Hyperglycemia within 72 h after a neurosurgical operation is associated with SSI.
      • Age, sex, BMI, insurance status, and race were not associated with development of SSI.
      • More patients who developed SSI required the use of an insulin drip postoperatively.
      • Age, BMI, pre-op HbA1c, procedure duration, and pre-op osteroids did not impact SSI.


      Elevated HbA1c is associated with increased surgical site infections (SSI) in neurosurgical patients. How blood glucose control in the early post-operative period relates to SSI is incompletely understood. We hypothesized that poor early post-operative blood glucose control would be associated with SSI. Data from patients undergoing neurosurgical procedures at University of Missouri Hospital was retrospectively collected. Post-operative blood glucose for 72 h after surgery was assessed and categorized by levels of hyperglycemia; those with glucose ≥200 mg/dl were classified as poorly controlled. Patients with SSI were compared to patients without SSI using Chi-Square test with Fisher’s exact test when appropriate. Of 500 patients having surgery, 300 had at least one post-operative blood glucose measurement. Of those 300 patients, 19 (6.33%) developed SSI. Patients with SSI had significantly higher mean post-operative blood glucose levels (p = 0.0081) and a greater mean number of point-of-care glucose level measurements >150 mg/dL (p = 0.0434). Pre-operative HbA1c and SSI were not associated (p = 0.0867). SSI was associated with pre-operative glucocorticoid use (p = 0.03), longer operative procedure (p = 0.0072), and required use of post-operative insulin drip (p = 0.047). Incidence of other wound complications (cellulitis, deep infection, dehiscence) increased with increase in post-operative blood glucose levels to >225 mg/dL. Post-operative hyperglycemia is associated with SSI after neurosurgical procedures, emphasizing the importance addressing blood glucose control after surgery.


      To read this article in full you will need to make a payment


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Anderson PA, Savage JW, Vaccaro AR, Radcliff K, Arnold PM, Lawrence BD, Shamji MF. Prevention of Surgical Site Infection in Spine Surgery. Neurosurgery. 2017; 80(3S):S114-S123. doi:10.1093/neuros/nyw066.

        • Badia J.M.
        • Casey A.L.
        • Petrosillo N.
        • Hudson P.M.
        • Mitchell S.A.
        • Crosby C.
        Impact of surgical site infection on healthcare costs and patient outcomes: a systemic review in six European countries.
        J Hosp Infect. 2017; 96: 1-15
        • Berríos-Torres S.I.
        • Umscheid C.A.
        • Bratzler D.W.
        • Leas B.
        • Stone E.C.
        • Kelz R.R.
        • et al.
        Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017.
        JAMA Surg. 2017; 152: 784
        • Pennington Z.
        • Lubelski D.
        • Westbroek E.M.
        • Ahmed A.K.
        • Passias P.G.
        • Sciubba D.M.
        Persistent postoperative hyperglycemia as a risk factor for operative treatment of deep wound infection after spine surgery.
        Neurosurgery. 2020; 87: 211-219
        • Meng F.
        • Cao J.
        • Meng X.
        Risk factors for surgical site infections following spinal surgery.
        J Clin Neurosci. 2015; 22: 1862-1866
        • Martin E.T.
        • Kaye K.S.
        • Knott C.
        • Nguyen H.
        • Santarossa M.
        • Evans R.
        • et al.
        Diabetes and risk of surgical site infection: a systematic review and meta-analysis.
        Infect Control Hosp Epidemiol. 2016; 37: 88-99
        • Yao R.
        • Zhou H.
        • Choma T.J.
        • Kwon B.K.
        • Street J.
        Surgical site infection in spine surgery: who is at risk?.
        Global Spine J. 2018; 8: 5S-30S
        • Moghissi E.S.
        • Korytkowski M.T.
        • DiNardo M.
        • Einhorn D.
        • Hellman R.
        • Hirsch I.B.
        • et al.
        American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control.
        Diabetes Care. 2009; 32: 1119-1131
        • Cagliero E.
        • Levina E.V.
        • Nathan D.M.
        Immediate feedback of HbA1c levels improves glycemic control in type 1 and insulin-treated type 2 diabetic patients.
        Diabetes Care. 1999; 22: 1785-1789
        • Nathan D.M.
        • Griffin A.
        • Perez F.M.
        • Basque E.
        • Do L.
        • Steiner B.
        Accuracy of a point-of-care hemoglobin A1c assay.
        J Diabetes Sci Technol. 2019; 13: 1149-1153
        • Perencevich E.N.
        • Sands K.E.
        • Cosgrove S.E.
        • Guadagnoli E.
        • Meara E.
        • Platt R.
        Health and economic impact of surgical site infections diagnosed after hospital discharge.
        Emerg Infect Dis. 2003; 9: 196-203
        • Lewis S.S.
        • Moehring R.W.
        • Chen L.F.
        • Sexton D.J.
        • Anderson D.J.
        Assessing the relative burden of hospital-acquired infections in a network of community hospitals.
        Infect Control Hosp Epidemiol. 2013; 34: 1229-1230
      2. de Vries FEE, Gans SL, Solomkin JS, Allegranzi B, Egger M, Dellinger EP, Boermeester MA. Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection. BJS 2017; 104(2):e95-e105. doi:10.1002/bjs.10424.

      3. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, Hirsch IB. Management of diabetes and hyperglycemia in hospitals [published correction appears in Diabetes Care. 2004 Mar;27(3):856. Hirsh, Irl B [corrected to Hirsch, Irl B]] [published correction appears in Diabetes Care. 2004 May;27(5):1255]. Diabetes Care. 2004;27(2):553-591. doi:10.2337/diacare.27.2.553.

      4. Tanaka T, Bradford T, Litofsky NS. The severity of preoperative HbA1c and predicting postoperative complications in spine surgery. Unpublished results.

        • Merkler A.E.
        • Saini V.
        • Kamel H.
        • Stieg P.E.
        Preoperative steroid use and the risk of infectious complications after neurosurgery.
        Neurohospitalist. 2014; 4: 80-85
        • Cheng H.
        • Chen B.P.
        • Soleas I.M.
        • Ferko N.C.
        • Cameron C.G.
        • Hinoul P.
        Prolonged operative duration increases risk of surgical site infections: a systematic review.
        Surg Infect. 2017; 18: 722-735
        • Ata A.
        • Lee J.
        • Bestle S.L.
        • Desemone J.
        • Stain S.C.
        Postoperative hyperglycemia and surgical site infection in general surgery patients.
        Arch Surg. 2010; 145: 858-864
        • Takesue Y.
        • Tsuchida T.
        Strict glycemic control to prevent surgical site infections in gastroenterological surgery.
        Ann Gastroenterol Surg. 2017; 1: 52-59
      5. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2009;94(3):709-728. doi:10.1210/jc.2008-1410.

        • Joshi G.P.
        • Chung F.
        • Vann M.A.
        • Ahmad S.
        • Gan T.J.
        • Goulson D.T.
        • et al.
        Society for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery.
        Anesth Analg. 2010; 111: 1378-1387
      6. Buchleitner AM, Martínez-Alonso M, Hernández M, Solà I, Mauricio D. Perioperative glycaemic control for diabetic patients undergoing surgery. Cochrane Database Syst Rev 2012;(9):CD007315. Published 2012 Sep 12. doi:10.1002/14651858.CD007315.pub2.

        • Urban J.A.
        Cost analysis of surgical site infections.
        Surg Infect (Larchmt). 2006; 7: S19-S22
        • Atkinson R.A.
        • Jones A.
        • Ousey K.
        • Stephenson J.
        Management and cost of surgical site infection in patients undergoing surgery for spinal metastasis.
        J Hosp Infect. 2017; 95: 148-153
        • Yeramaneni S.
        • Robinson C.
        • Hostin R.
        Impact of spine surgery complications on costs associated with management of adult spinal deformity.
        Curr Rev Musculoskelet Med. 2016; 9: 327-332