From the patient ’s perspective , an infection delays healing , can increase time away from work or family , and can cause additional pain and complications ( eg , sepsis , long-term disabilities , death ) .
urgical site infections ( SSIs ) continue to cause significant patient harm despite many advances in Sinfection prevention .
The negative effects of SSIs on morbidity , mortality , and the cost of care has kept SSI reduction a top priority for health care organizations worldwide .
A 2011 systematic review found that approximately 55 % of SSIs in the United States may be preventable by using evidence -based guidelines .
Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery)
OBJECTIVE The optimal treatment of hyperglycemia in general surgical patients with type 2 diabetes mellitus is not known . RESEARCH DESIGN AND METHODS This r and omized multicenter trial compared the safety and efficacy of a basal-bolus insulin regimen with glargine once daily and glulisine before meals ( n = 104 ) to sliding scale regular insulin ( SSI ) four times daily ( n = 107 ) in patients with type 2 diabetes mellitus undergoing general surgery . Outcomes included differences in daily blood glucose ( BG ) and a composite of postoperative complications including wound infection , pneumonia , bacteremia , and respiratory and acute renal failure . RESULTS The mean daily glucose concentration after the 1st day of basal-bolus insulin and SSI was 145 ± 32 mg/dL and 172 ± 47 mg/dL , respectively ( P < 0.01 ) . Glucose readings < 140 mg/dL were recorded in 55 % of patients in basal-bolus and 31 % in the SSI group ( P < 0.001 ) . There were reductions with basal-bolus as compared with SSI in the composite outcome [ 24.3 and 8.6 % ; odds ratio 3.39 ( 95 % CI 1.50–7.65 ) ; P = 0.003 ] . Glucose < 70 mg/dL was reported in 23.1 % of patients in the basal-bolus group and 4.7 % in the SSI group ( P < 0.001 ) , but there were no significant differences in the frequency of BG < 40 mg/dL between groups ( P = 0.057 ) . CONCLUSIONS Basal-bolus treatment with glargine once daily plus glulisine before meals improved glycemic control and reduced hospital complications compared with SSI in general surgery patients . Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the hospital management of general surgery patients with type 2 diabetes
From the patient ’s perspective , an infection delays healing , can increase time away from work or family , and can cause additional pain and complications ( eg , sepsis , long-term disabilities , death ) .
urgical site infections ( SSIs ) continue to cause significant patient harm despite many advances in Sinfection prevention .
The negative effects of SSIs on morbidity , mortality , and the cost of care has kept SSI reduction a top priority for health care organizations worldwide .
A 2011 systematic review found that approximately 55 % of SSIs in the United States may be preventable by using evidence -based guidelines .