Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database

Mohan, Sathish; Kaoutzanis, Christodoulos; Welch, Kathleen B.; Vandewarker, James F.; Winter, Sidney G.; Krapohl, Greta L.; Lampman, Richard M.; Franz, Michael; Cleary, Robert K.

doi:10.1007/s00384-015-2322-7

Cited by 40 publications

(33 citation statements)

References 19 publications

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“…Other authors, using The Michigan Surgical Quality Collaborative database, assessed the relationship between high blood glucose levels in the early postoperative period after colorectal operations and found that superficial surgical site infections, sepsis, and death were associated with postoperative serum hyperglycemia in patients without diabetes and concluded that glucose monitoring is critical for all patients undergoing colorectal surgery. 17 In addition, clinical outcomes associated with postoperative hyperglycemia in cardiac surgery patients who were stratified by diabetes status demonstrated that in patients without diabetes, hyperglycemia ($180 mg/dL) was associated with an increase in infections and respiratory complications. 18 A systematic review of the effects of tight glycemic control (blood glucose levels #200 mg/ dL) reported a reduction in the incidence of surgical site infections in adult patients with diabetes after cardiac surgery.…”

Section: Discussionmentioning

confidence: 98%

The association of postoperative glycemic control and lower extremity procedure outcomes

Vogel

Smith

Kruse

2017

Journal of Vascular Surgery

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One in five patients undergoing vascular procedures had postoperative hyperglycemia. Postoperative hyperglycemia was associated with adverse events after lower extremity vascular procedures in patients with and without diabetes, including infection, increased hospital utilization, and mortality. No difference was found with respect to hospital readmission. Postprocedure glucose management may represent an important quality marker for improving outcomes after lower extremity vascular procedures.

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Section: Discussionmentioning

confidence: 98%

The association of postoperative glycemic control and lower extremity procedure outcomes

Vogel

Smith

Kruse

2017

Journal of Vascular Surgery

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“…Изучение влияния гипергликемии на клиниче-ские исходы у пациентов хирургического профиля с СД или без него привлекает все больше исследовате-лей [35][36][37]. Длительное время послеоперационная СГ рассматривалась как адаптационная реакция на стресс, и ее коррекции не уделяли большого внимания.…”

Section: инсулинорезистентность и стрессовая гипергликемияunclassified

“…при изучении уровня гликемии и риска инфекционных осложнений в колоректаль-ной хирургии у 5145 пациентов, среди которых 1072 имели СД, отметили, что повышение гликемии более 10 ммоль/л у пациентов без СД сопровождалось повы-шением риска развития нагноения послеоперационной раны (OR (odds ratio) 1,53; p=0,03), сепсиса (OR 1,61; p<0,01) и летальности (OR 2,26; p<0,01), в отличие от па-циентов с СД, у которых значимой взаимосвязи между гипергликемией и инфекционными осложнениями по-лучено не было [37].…”

Section: инсулинорезистентность и стрессовая гипергликемияunclassified

Post-operative insulin resistance

Tarasova¹,

Shestakov²,

Zubova³

2017

Diabetes mellitus

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Вопросы патогенезаPathogenesis настоящее время под инсулинорезистентностью (ИР) понимают снижение биологического от-вета к одному или нескольким эффектам дей-ствия инсулина [1]. Наиболее часто ИР определяют как состояние, которое сопровождается снижением ути-лизации глюкозы тканями в ответ на действие инсулина, т.е. резистентностью органов и тканей к сахароснижаю-щему действию инсулина [2].Феномен ИР был описан в 1939 г. Himsworth H.P. и Kerr R.B. для определения недостаточного ответа на введение экзогенного инсулина у больных сахар-ным диабетом 2 типа (СД2) и ожирением [3]. В даль-нейшем ИР была выявлена и при других состояниях у пациентов без предшествующего СД, например при беременности, уремии, после обширных травм, ожо-гов [4][5][6]. Инсулинорезистентность после хирургических вмешательств

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“…1 Van den Berghe et al showed a 30% decrease in mortality of critically ill patients, whose glucose levels were kept within strict margins to prevent hyperglycemia. 5 Moreover, perioperative hyperglycemia is known to correlate with a variety of complications such as postoperative infections, [6][7][8][9][10] increased delirium rates, 11 renal failure 12 and impaired immune function. 13 In addition, hyperglycemia negatively affects the human brain.…”

Section: Introductionmentioning

confidence: 99%

Impact of Intraoperative Hyperglycemia on Brain Structures and Volumes

Lachmann

Spies

Windmann

et al. 2018

Journal of Neuroimaging

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BACKGROUND AND PURPOSE In hyperglycemic patients, who succumbed to septic shock, an increased rate of apoptosis of microglial cells and damaged neurons of the hippocampus were found. However, the influence of perioperative glucose levels on hippocampal brain structures has not yet been investigated. METHODS As part of the ongoing BIOCOG project, a subgroup of N = 65 elderly nondemented patients were analyzed who underwent elective surgery of ≥60 minutes. In these patients, at least one intraoperative blood glucose (BG) measurement was available from the medical charts. Intraoperative glucose maximum was determined in each patient. Preoperatively and at 3 months follow‐up, structural neuroimaging was performed with T1‐weighted magnetization prepared rapid gradient‐echo sequence (MP‐Rage) and a dedicated high‐resolution hippocampus magnetic resonance imaging (MRI). The MRI scans were analyzed to assess pre‐ or postoperative volume changes of the hippocampus as a whole and hippocampal subfields. We also assessed changes of frontal lobe volume and cortical thickness. RESULTS Overall, 173 intraoperative BG levels were obtained in 65 patients (median 2 per patient). A total of 18 patients showed intraoperative hyperglycemia (glucose maximum ≥150 mg/dL). Controlling for age and diabetes status, no significant impact of intraoperative hyperglycemia was found on the pre–post volume change of the hippocampus as a whole, hippocampal subfields, frontal lobe, and frontal cortical thickness. CONCLUSIONS This study found no effect of intraoperative hyperglycemia on postoperative brain structures and volumes including volumes of hippocampus and hippocampal subfields, frontal lobe, and frontal cortical thickness. Further studies investigating the impact of intraoperatively elevated glucose levels should consider a tighter or even continuous glycemic measurement and the determination of central microglial activation.

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Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database

Abstract: Following colorectal operations, superficial SSI, sepsis, and death are associated with postoperative serum hyperglycemia in patients without diabetes, but not those with diabetes. Vigilant postoperative BG monitoring is critical for all patients undergoing colorectal surgery.

Cited by 40 publications

References 19 publications

The association of postoperative glycemic control and lower extremity procedure outcomes

The association of postoperative glycemic control and lower extremity procedure outcomes

Post-operative insulin resistance

Impact of Intraoperative Hyperglycemia on Brain Structures and Volumes

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