Despite improvements in surgical techniques and perioperative care, the high incidence of postoperative surgical site infections remains a major problem in patients undergoing major abdominal surgery (liver, pancreatic and colorectal surgery).
Using the hyperinsulinemic-normoglycemic clamp technique, i.e. continuous infusion of insulin combined with dextrose titrated to "clamp" blood glucose between 4 and 6 mmol/L, we successfully established and preserved normoglycemia during the perioperative period. Our objective of this study is to determine if the maintenance of perioperative normoglycemia by a hyperinsulinemic normoglycemic clamp reduces the rates of incisional and space/ surgical site infections following abdominal surgery (liver, pancreatic and colorectal surgery).
> 18 years old
elective liver, pancreatic or colorectal surgery
ability to give informed consent
None
Single group
Hyperinsulinemic normoglycemic clamp
Other interventionPatients will receive an IV infusion of 2 mU/kg/min (0.12 U/kg/hour) starting in the operating room. Dextrose 20% will be titrated to maintain blood glucose between 4 and 6 mmol/l. At the end of surgery, the insulin infusion will be stopped and the dextrose infusion weaned off in the postanesthesia care unit.
Standard glucose management
Other interventionBlood glucose levels will be treated by a standard insulin sliding scale.
Surgical site infection
Surgical site infections will be defined according to the CDC's NNIS system.
Surgical morbidity
Surgical morbidity in the 30 days following the operation will be assessed as per Clavien score.
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