• J. Cardiothorac. Vasc. Anesth. · Mar 2022

    Surgical Site Infections and Inflammatory Reaction After Cardiac Surgery; Bedside Artificial Pancreas Versus Conventional Insulin Therapy: A Propensity Score-Matched Analysis.

    • Tasuku Fujii, Takahiro Hirai, Shogo Suzuki, and Kimitoshi Nishiwaki.
    • Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan. Electronic address: plus9@med.nagoya-u.ac.jp.
    • J. Cardiothorac. Vasc. Anesth. 2022 Mar 1; 36 (3): 840-846.

    ObjectivesPerioperative hyperglycemia is associated with poor postoperative recovery, including compromised immune function and increased risk of infection. A closed-loop glycemic control system (artificial pancreas) has demonstrated strict safe perioperative glycemic control without hypoglycemia risk. The authors hypothesized that the artificial pancreas would reduce surgical site infections (SSIs) and postoperative inflammatory reactions. This study aimed to assess the effect of the artificial pancreas on SSIs and C-reactive protein (CRP) levels after cardiac surgery.DesignA single-center retrospective, propensity score-matched analysis.SettingA university hospital.ParticipantsIn total, 295 patients who underwent cardiovascular surgery with cardiopulmonary bypass were included.InterventionsPatients were divided into two groups: artificial pancreas (target blood glucose: 120-150 mg/dL) and intravenous insulin infusion (conventional insulin therapy, target blood glucose: <200 mg/dL).Measurements And Main ResultsThe differences in the incidence of SSIs and CRP levels between the two groups were assessed. After 1:1 propensity score matching based on their covariates, 101 matched patients were selected from each group. The incidence of SSIs was reduced by 3%, 5% (conventional insulin therapy), and 2% (artificial pancreas), but the reduction was not statistically significant (p = 0.45). The postoperative maximum CRP level was significantly lower in the artificial pancreas group than in the conventional insulin therapy group, mean (standard deviation)14.53 (5.64) mg/dL v 16.57 (5.58) mg/dL; p = 0.01.ConclusionsThe artificial pancreas did not demonstrate a significant reduction in the incidence of SSIs. However, the artificial pancreas was safe and suppressed postoperative inflammation compared with conventional insulin therapy.Copyright © 2021 Elsevier Inc. All rights reserved.

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