Stress-induced hyperglycaemia in elective long bone fracture fixation and the risk of surgical sites infection

Background: Stress-induced hyperglycaemia (SIH) is linked to poor outcomes in surgical patients, including those undergoing orthopaedic procedures. Despite this, data on the frequency of SIH and its association with surgical site infection (SSI) in elective orthopaedic surgery is limited in our setting. This study aimed to determine the frequency of SIH in patients undergoing elective long bone fracture fixation and assess its relationship with SSI. Methodology: A prospective cohort study was conducted from April 2021 to March 2022 involving 50 adult patients undergoing elective long bone fracture fixation. Random blood sugar (RBS) was measured peri-operatively: after anaesthesia induction, at wound closure, and on post-operative days (POD) 1, 2, and 5. Patients were categorized into normoglycaemia and SIH groups. Wounds were inspected on POD 5 and weekly until the 4th postoperative week. Data were analysed using SPSS version 20. Results: SIH was observed in 10% of patients. The mean RBS associated with increased SSI risk was 112.8±22.1mg/dl. Mean RBS values were 102.4±13.0 (pre-op), 162.7±31.8 (intra-op), and 190.2±42.5mg/dl (POD 1–2), with significant differences between SIH and normoglycaemic groups (p=0.00). There was no significant difference in mean RBS on the operative day (p=0.58) or POD 5 (p=0.61). A strong correlation between elevated glucose and SSI was found. Conclusion: SIH occurred in 10% of cases. A mean RBS of 112.8mg/dl was linked to higher SSI risk. Blood glucose peaked by POD 2, but remained elevated in those who developed infections.