Hypoglycemic exposure and glycemic variability are associated with surgical site infection after cardiac surgery
5 affiliations
- 1Diabetes Service, IRCCS ISMETT
- 2Department of Research, IRCCS ISMETT
- 3UPMC Italy
- 4Department of Health Promotion, Mother and Childcare, Internal Medicine and Medical Specialties, School of Medicine, University of Palermo
- 5Department of Internal Medicine and Pediatrics, Ghent University
Abstract
Perioperative hyperglycemia is a recognized risk factor for surgical site infection (SSI) after cardiac surgery. However, the independent contribution of hypoglycemic exposure and glycemic variability remains incompletely defined. We evaluated whether perioperative dynamic glycemic metrics are associated with SSI risk after cardiac surgery independently of chronic glycemic control. We conducted a historical cohort study at a high-volume tertiary referral center. Among 4,425 consecutive adult patients undergoing open cardiac surgery between 2014 and 2022, 462 patients with diabetes or perioperative hyperglycemia and high-density glucose monitoring (≥ 4 measurements/day) were included. Time below range (TBR), time in range (TIR), time above range (TAR), and coefficient of variation (CV) were calculated. The primary outcome was SSI within 90 days, defined using Centers for Disease Control and Prevention (CDC) criteria. Associations were evaluated using logistic regression adjusted for age and sex, with sensitivity analyses including HbA1c and clinical covariates. SSI occurred in 32 patients (6.9%). Patients with SSI had higher CV (p = 0.0094), higher TBR (p < 0.0001), higher TAR (p = 0.0419), lower TIR (p = 0.0112), and higher HbA1c (p = 0.0055). In adjusted analyses, CV (OR 1.47 per 5% increase, p = 0.0005) and TBR (OR 1.69 per 1% increase, p < 0.0001) were independently associated with SSI, and any hypoglycemia (TBR > 0) was also associated with higher SSI risk. Higher TIR was associated with lower SSI risk (OR 0.75 per 10% increase, p = 0.0013). After adjustment for HbA1c, TBR and CV remained independently associated with SSI. Perioperative hypoglycemic exposure and greater glycemic variability were strongly and independently associated with SSI after cardiac surgery. These findings support greater attention to glycemic stability and hypoglycemia avoidance, beyond average glycemic control, in perioperative glucose management.
Related
- Visit-to-Visit Blood Pressure Variability, Glycemic Status and the Risk of Dementia, Stroke, and All-Cause Mortality: A UK Biobank Cohort Study
- Suspected Pasteurella Infection Associated With Catnip Exposure Leading to Finger Extensor Tendon Rupture: A Case Report.
- Ketoacidosis at Hypoglycemic and Low Glucose Levels Associated with SGLT2 Inhibitor Use: A Descriptive Systematic Review of Published Cases
- Early Glycemic Variability from Routine Glucose Measurements, Diabetes Status, and In-Hospital Mortality in Sepsis: A 14-Year Retrospective Cohort Study
- Continuous glucose monitoring reveals thyroid feedback-related residual glycemic variability and hypoglycemia during inpatient glucose optimization in euthyroid adults with type 2 diabetes: a CGM-based observational study.
BibTeX
@article{mattina2026hypoglycemic,
title = {{Hypoglycemic exposure and glycemic variability are associated with surgical site infection after cardiac surgery}},
author = {Alessandro Mattina and Diego Bellavia and Elena Conoscenti and Maria Ausilia Giusti and Marco Morsolini and Vitale Miceli and Alessandra Mularoni and Manfredi Rizzo and Stijn Blot and Massimo Pinzani},
journal = {Scientific Reports},
year = {2026},
month = aug,
doi = {10.1038/s41598-026-65173-5},
url = {https://doi.org/10.1038/s41598-026-65173-5},
note = {CC BY},
}
RIS
TY - JOUR
TI - Hypoglycemic exposure and glycemic variability are associated with surgical site infection after cardiac surgery
AU - Alessandro Mattina
AU - Diego Bellavia
AU - Elena Conoscenti
AU - Maria Ausilia Giusti
AU - Marco Morsolini
AU - Vitale Miceli
AU - Alessandra Mularoni
AU - Manfredi Rizzo
AU - Stijn Blot
AU - Massimo Pinzani
PY - 2026
DA - 2026/08/01
JO - Scientific Reports
DO - 10.1038/s41598-026-65173-5
UR - https://doi.org/10.1038/s41598-026-65173-5
AB - Perioperative hyperglycemia is a recognized risk factor for surgical site infection (SSI) after cardiac surgery. However, the independent contribution of hypoglycemic exposure and glycemic variability remains incompletely defined. We evaluated whether perioperative dynamic glycemic metrics are associated with SSI risk after cardiac surgery independently of chronic glycemic control. We conducted a historical cohort study at a high-volume tertiary referral center. Among 4,425 consecutive adult patients undergoing open cardiac surgery between 2014 and 2022, 462 patients with diabetes or perioperative hyperglycemia and high-density glucose monitoring (≥ 4 measurements/day) were included. Time below range (TBR), time in range (TIR), time above range (TAR), and coefficient of variation (CV) were calculated. The primary outcome was SSI within 90 days, defined using Centers for Disease Control and Prevention (CDC) criteria. Associations were evaluated using logistic regression adjusted for age and sex, with sensitivity analyses including HbA1c and clinical covariates. SSI occurred in 32 patients (6.9%). Patients with SSI had higher CV (p = 0.0094), higher TBR (p < 0.0001), higher TAR (p = 0.0419), lower TIR (p = 0.0112), and higher HbA1c (p = 0.0055). In adjusted analyses, CV (OR 1.47 per 5% increase, p = 0.0005) and TBR (OR 1.69 per 1% increase, p < 0.0001) were independently associated with SSI, and any hypoglycemia (TBR > 0) was also associated with higher SSI risk. Higher TIR was associated with lower SSI risk (OR 0.75 per 10% increase, p = 0.0013). After adjustment for HbA1c, TBR and CV remained independently associated with SSI. Perioperative hypoglycemic exposure and greater glycemic variability were strongly and independently associated with SSI after cardiac surgery. These findings support greater attention to glycemic stability and hypoglycemia avoidance, beyond average glycemic control, in perioperative glucose management.
SN - 2045-2322
ER -