The relationship of preoperative versus postoperative hyperglycemia on clinical outcomes after elective colorectal surgery

Chen, Edmund B.; Nooromid, Michael J.; Helenowski, Irene; Soper, Nathaniel J.; Halverson, Amy L.

doi:10.1016/j.surg.2019.04.043

Cited by 17 publications

(21 citation statements)

References 18 publications

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“…For example, of the seven observational studies in orthopaedic surgery published in the last decade that examined hyperglycaemia and postoperative outcome in people with and without diabetes, all analysed those with and without the condition together. These types of analyses are also present in all studies in head and neck [15], thoracic [16], hepatobiliary [17–19] and neurosurgery [20, 21] and in the majority of papers in cardiac [22–31], lower [32–34] and upper [34, 35] gastro‐intestinal surgery. People with diabetes have increased risk of cardiovascular, renal, ophthalmic and neurological morbidities.…”

Section: Discussionmentioning

confidence: 98%

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Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population‐based study in UK Biobank

et al. 2022

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Summary The aim of our study was to clarify the association between glycated haemoglobin (HbA1c) and postoperative outcomes in people without an existing diagnosis of diabetes. Half a million adults were recruited into the UK Biobank prospective cohort study between March 2006 and October 2010. We divided participants into three groups: no diagnosis of diabetes and HbA1c < 42 mmol.mol−1; no diagnosis of diabetes and elevated HbA1c (≥ 42 mmol.mol−1 with no upper limit); and prevalent diabetes (regardless of HbA1c concentration) at recruitment. We followed up participants by linkage with routinely collected hospital data to determine any surgical procedures undertaken after recruitment and the associated postoperative outcomes. Our main outcome measure was a composite primary outcome of 30‐day major postoperative complications and 90‐day all‐cause mortality. We used logistic regression to estimate the odds of the primary outcome by group. We limited analyses to those who underwent surgery within one year of recruitment (n = 26,653). In a combined effects logistic regression model, participants not known to have diabetes with HbA1c ≥ 42 mmol.mol−1 had increased odds of the primary outcome (OR [95% CI] 1.43 [1.02–2.02]; p = 0.04), when compared with those without diabetes and HbA1c < 42 mmol.mol−1. This effect was attenuated and no longer statistically significant in a direct effects model with adjustment for hyperglycaemia‐related comorbidity (OR [95% CI] 1.37 [0.97–1.93]; p = 0.07). Elevated pre‐operative HbA1c in people without diabetes may be associated with an increased risk of complications, but the association is likely confounded by end‐organ comorbidity. In contrast to previous evidence, our findings suggest that to prevent adverse postoperative outcomes, optimisation of pre‐existing morbidity should take precedence over reducing HbA1c in people without diabetes.

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Section: Discussionmentioning

confidence: 98%

“…hepatobiliary [17][18][19] and neurosurgery [20,21] and in the majority of papers in cardiac [22][23][24][25][26][27][28][29][30][31], lower [32][33][34] and upper [34,35] gastro-intestinal surgery. People with diabetes have increased risk of cardiovascular, renal, ophthalmic and neurological morbidities.…”

Section: Discussionmentioning

confidence: 99%

Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population‐based study in UK Biobank

et al. 2022

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“…A higher level of preoperative FPG could indicate a harsher state of insulin resistance, which is also associated with poor outcomes for surgical patients ( Gillis and Carli, 2015 ). Finally, since poor preoperative glucose control is independently associated with postoperative hyperglycemia ( Godshaw et al, 2018 ; Chen et al, 2019 ), and postoperative hyperglycemia leads to a higher rate of adverse events after surgery ( Kwon et al, 2013 ), adverse effects of preoperative FPG ≥ 7 mmol/L could be worsened in surgical patients with type 2 DM.…”

Section: Discussionmentioning

confidence: 99%

Preoperative hyperglycemia is associated with elevated risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery: A retrospective cohort study

Liu

Shi²,

Wang³

et al. 2022

Front. Aging Neurosci.

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BackgroundDiabetes mellitus (DM) has been reported to be associated with perioperative stroke, but the effects of preoperative hyperglycemia on the risk of perioperative stroke in diabetic patients undergoing non-cardiovascular surgery remain unclear. This study investigated the association between preoperative hyperglycemia and the risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery.MethodsThis retrospective cohort study screened 27,002 patients with type 2 DM undergoing non-cardiovascular surgery with general anesthesia between January 2008 and August 2019 at The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital. The exposure of interest was preoperative hyperglycemia, defined as a fasting plasma glucose (FPG) ≥ 7 mmol/L. The outcome of interest was a new diagnosis of perioperative ischemic stroke within 30 days after surgery. Residual confounding was minimized by controlling for observable patient and intraoperative factors. Logistic regression was conducted in the total and propensity score matched cohorts. In addition, we stratified patients into six subgroups to investigate whether the association between preoperative hyperglycemia and perioperative ischemic stroke differs in these subgroups.ResultsThe overall incidence of perioperative ischemic stroke was 0.53% (n = 144) in the current cohort. The odds of perioperative ischemic stroke were significantly increased for patients with preoperative hyperglycemia after adjusting for patient- related variables (OR: 1.95; 95% CI: 1.39–2.75; p < 0.001), surgery-related variables (OR: 2.1; 95% CI: 1.51–2.94; p < 0.001), and all confounding variables (OR: 1.78; 95% CI: 1.26–2.53; p < 0.001). The risk of perioperative stroke was significantly increased in patients with preoperative hyperglycemia (OR: 2.51; 95% CI: 1.66–3.9; p < 0.001) in the propensity score matched cohort. Preoperative hyperglycemia was associated with the outcome for all the subgroups except for patients undergoing neurosurgery.ConclusionPreoperative hyperglycemia is associated with an elevated risk of perioperative stroke in patients with type 2 DM undergoing non-cardiovascular surgery. The effect could be eliminated for patients undergoing neurosurgery, during which specific risk factors should be considered.

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“…There is no commonly accepted definition of postoperative hyperglycemia (35). The adopted cutoff points varied among different studies and included 7.0 mmol/L (12, 36), 8.0 mmol/L (17,18,37), 10.0 mmol/L (7,17,37,38), and 11.1 mmol/L (12, The Kaplan-Meier curves of overall survival in all patients. When compared with patients with TWA BG <8.0 mmol/L, the risk of 3-year death remained higher in those with TWA BG 8.0 to 10.0 mmol/L (adjusted HR 2.28, 95% CI 1.47 to 3.54, P < 0.001) and with TWA BG >10.0 mmol/L (adjusted HR 2.00, 95% CI 1.29 to 3.10, P = 0.002) after adjustment for confounding factors including age, sex, body mass index, chronic smoking, history of type II diabetes mellitus, American Society of Anesthesiologists classification, preoperative Barthel Index, preoperative hemoglobin, preoperative albumin, tumor-node-metastasis stage, type of anesthesia, site of surgery, Operative Stress Score, duration of surgery, intraoperative blood transfusion, endotracheal intubation on ICU admission, delirium within 7 days, and non-delirium complications within 30 days.…”

Section: Discussionmentioning

confidence: 99%

Hyperglycemia is associated with worse 3-year survival in older patients admitted to the intensive care unit after non-cardiac surgery: Post hoc analysis of a randomized trial

Deng²,

Su³

et al. 2022

Front. Med.

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ObjectiveHyperglycemia is common in critically ill patients after surgery and is associated with worse perioperative outcomes. Yet, the impact of postoperative hyperglycemia on long-term outcomes remains unclear. We therefore analyzed the association between early postoperative hyperglycemia and 3-year overall survival in older patients who were admitted to the intensive care unit after surgery.MethodsThis was a post hoc analysis of database obtained from a previous randomized trial and 3-year follow-up. The underlying trial enrolled 700 patients aged 65 years or older who were admitted to the intensive care unit after elective non-cardiac surgery. Early postoperative time-weighted average blood glucose was calculated and was divided into three levels, i.e., <8.0 mmol/L, from 8.0 to 10.0 mmol/L, and >10.0 mmol/L. The primary outcome was 3-year overall survival. The association between time-weighted average blood glucose level and 3-year overall survival was analyzed with Cox proportional hazard regression models. Subgroup analyses were also performed in patients with or without diabetes, and in patients following cancer or non-cancer surgery.ResultsA total of 677 patients (mean age 74 years, 60% male sex) were included in the final analysis. Within 3 years after surgery, deaths occurred in 22.1% (30/136) of patients with time-weighted average blood glucose <8.0 mmol/L, compared with 35.7% (81/227) of those from 8.0 to 10.0 mmol/L (unadjusted hazard ratio 1.75, 95% CI 1.15 to 2.67, P = 0.009), and 36.9% (116/314) of those >10.0 mmol/L (unadjusted hazard ratio 1.91, 95% CI 1.28 to 2.85, P = 0.002). After adjustment for confounding factors, the risk of 3-year mortality remained higher in patients with time-weighted average blood glucose from 8.0 to 10.0 mmol/L (adjusted hazard ratio 2.28, 95% CI 1.47 to 3.54, P < 0.001) and in those >10.0 mmol/L (adjusted hazard ratio 2.00, 95% CI 1.29 to 3.10, P = 0.002). Similar results were obtained in the subgroups of patients without diabetes and patients following cancer surgery.ConclusionFor older patients admitted to the intensive care unit after elective non-cardiac surgery, high early blood glucose (time-weighted average blood glucose ≥ 8.0 mmol/L) was associated with poor 3-year overall survival. The impact of moderate glycemic control on long-term survival deserves further investigation.

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The relationship of preoperative versus postoperative hyperglycemia on clinical outcomes after elective colorectal surgery

Cited by 17 publications

References 18 publications

Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population‐based study in UK Biobank

Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population‐based study in UK Biobank

Preoperative hyperglycemia is associated with elevated risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery: A retrospective cohort study

Hyperglycemia is associated with worse 3-year survival in older patients admitted to the intensive care unit after non-cardiac surgery: Post hoc analysis of a randomized trial

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