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

摘要

Objectives: Perioperative 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 con-trol without hypoglycemia risk. The authors hypothesized that the artificial pancreas would reduce surgical site infections (SSIs) and postopera-tive inflammatory reactions. This study aimed to assess the effect of the artificial pancreas on SSIs and C-reactive protein (CRP) levels after cardiac surgery. Design: A single-center retrospective, propensity score-matched analysis. Setting: A university hospital. Participants: In total, 295 patients who underwent cardiovascular surgery with cardiopulmonary bypass were included. Interventions: Patients 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 Results: The differences in the incidence of SSIs and CRP levels between the two groups were assessed. After 1:1 pro-pensity 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 postopera-tive 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. Conclusions: The 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. (C) 2021 Elsevier Inc. All rights reserved.