Preoperative Blood Glucose Level Predicts Postsurgical Gastroparesis Syndrome after Subtotal Gastrectomy: Development of an Individualized Usable Nomogram

Abstract

Background. Postsurgical gastroparesis syndrome (PGS) after subtotal gastrectomy imposes significant social and economic burdens. We aimed to investigate the relationship between preoperative blood glucose level and PGS and develop a nomogram for individualized prediction. Patients and Methods. We retrospectively analyzed 633 patients with gastric cancer who underwent subtotal gastrectomy. Preoperative blood glucose levels were evaluated via receiver operating characteristic (ROC) curve analysis. Chi-squared tests and multivariable logistic regression analyses were used to develop a predictive model for PGS, presented as a nomogram, which was assessed for its clinical usefulness. Results. Thirty-eight of 633 patients were diagnosed with PGS. Based on the ROC curve analysis, the preoperative blood glucose cutoff value for PGS was 6.25 mmol/L. The predictors of PGS included preoperative hyperglycemia (odds ratio (OR) 2.3, P=0.03), body mass index (BMI; OR 0.21, P=0.14 for BMI<18.5 and OR 3.0, P=0.004 for BMI>24), and the anastomotic method (OR 7.3, P=0.001 for Billroth II and OR 5.9, P=0.15 for Roux-en-Y). The predictive model showed good discrimination ability, with a C-index of 0.710, and was clinically useful. Conclusions. Preoperative hyperglycemia effectively predicts PGS. We present a nomogram incorporating the preoperative blood glucose level, BMI, anastomotic method, and tumor size, for individualized prediction of PGS.

Clinical Significance of Perioperative Hyperglycemia in Radical Gastrectomy Among Non- diabetic Patients: Evidence for Better Perioperative Glucose Management in Different Anastomotic Methods

“…Unlike previous studies that demonstrated that poor perioperative glycemic control was related to worse postoperative outcomes in nondiabetic patients after gastric surgery [2,6,17], no signi cant difference was found between perioperative HG, whether preoperative or postoperative, and postoperative complications in the total population. Considering the different in uences of the normal physiological anatomy of the digestive tract on postoperative blood glucose levels in various anastomotic methods after radical gastrectomy, we subdivided the cohort into Billroth-I and non-Billroth-I groups.…”

Assessment of risk factors for delayed gastric emptying after distal gastrectomy for gastric cancer

“…We believe that RY reconstruction with a small remnant stomach helps reduce the incidence of DGE. However, in contrast, the incidence of functional DGE (also known as RSS) following RY reconstruction is reportedly higher than that after Billroth I reconstruction 18 , 19 . Many causes of RSS have been proposed, including ectopic pacemakers originating in the Roux limb, driving contractions in a reverse direction, and gastroparesis of the remnant stomach after vagotomy 20 – 22 .…”

“…Since it is difficult to achieve strict glycemic control in the postsurgical period due to unstable food intake and continuous intravenous infusion, some patients develop a hyperglycemic condition, which in turn may lead to DGE. Mao et al reported that preoperative hyperglycemia, rather than hemoglobin A1c levels, could effectively predict DGE following subtotal gastrectomy and presented a model that incorporated multiple risk factors to predict postsurgical gastroparesis 18 . Considering the physiological relationship between hyperglycemia and DGE, such a predictive model can prove especially useful.…”

Preoperative fasting glucose value can predict acute kidney injury in non-cardiac surgical patients without diabetes but not in patients with diabetes

“…Preoperative hyperglycemia is associated with an increased risk of postoperative complications (Davis et al 2012 ; Mao et al 2020 ; Noordzij et al 2007 ). Hyperglycemia can often occur before surgery in diabetic patients(glycemic poor control) and non-diabetic patients(unrecognized DM or stress).…”