Intensive preoperative glucose management including hospitalization is associated with lower surgical site infection in patients with diabetes: A retrospective multicenter observational study

AIMS: Perioperative glycemic control reduces surgical complications, such as surgical site infection (SSI), but evidence regarding the effect of preoperative hospitalization for this purpose is limited. In Japan, some patients with diabetes are admitted for 1-2 weeks before surgery to achieve glycemic stabilization, but the clinical benefits remain uncertain. We evaluated the association between preoperative hospitalization for glycemic optimization and perioperative outcomes. RESEARCH DESIGNS AND METHODS: We retrospectively analyzed 1,086 patients whose perioperative glycemic control was managed by diabetologists at four hospitals. Of these, 349 underwent preoperative management with hospitalization, 702 underwent preoperative management without hospitalization, and 35 underwent postoperative management only. The primary outcome was SSI, and secondary outcomes were postoperative hospital stay and antimicrobial therapy duration. RESULTS: The incidence of SSI was 7.2, 11.1, and 20.0% in the three groups, respectively (P = 0.020). Baseline HbA1c levels were 8.6, 7.2, and 7.1%, respectively. Preoperative hospitalization was associated with lower odds of SSI (OR 0.62, 95% confidence interval 0.39-0.99, P = 0.044). Postoperative hospital stay and antimicrobial therapy were shorter in the preoperative hospitalization group. Postoperative day 1 fasting glucose showed a stronger association with SSI than preoperative glucose, while fasting glucose on the day of surgery remained clinically informative. CONCLUSION: Preoperative inpatient glycemic management was associated with a lower risk of SSI. Although postoperative day 1 glucose showed the strongest association with SSI, fasting glucose on the day of surgery also appeared clinically informative. These findings support coordinated glycemic optimization beginning before surgery and continuing through the early postoperative period.