Bala G Nair1, Moni B Neradilek2, Shu-Fang Newman3, Mayumi Horibe4. 1. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA. Electronic address: nairbg@uw.edu. 2. The Mountain-Whisper-Light Statistics LLC, Seattle, WA, USA. Electronic address: moni@mwlight.com. 3. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA. Electronic address: sufu@uw.edu. 4. Department of Anesthesiology, VA Puget Sound Health Care System, Seattle, WA, USA. Electronic address: Mayumi.Horibe@va.gov.
Abstract
BACKGROUND: The relationship between acute phase perioperative hyperglycemia and postoperative outcome is poorly understood. METHODS: Retrospective cohort study of diabetic and non-diabetic adult patients undergoing non-cardiac surgery. Mean glucose and glycemic variability during the intraoperative and immediate postoperative periods were compared to length of stay, 30-day mortality, and postoperative complications. RESULTS: . DIABETIC PATIENTS (N = 1096): Higher glycemic variability was associated with longer hospital length of stay (0.32 day per 10 mg/dL) and greater 30-day mortality risk (OR = 1.42). Higher mean glucose (OR = 1.07) and glycemic variability (OR = 1.11) were associated with higher risk of complications. NON-DIABETIC PATIENTS (N = 1012): Both higher mean glucose (0.29 day per 10 mg/dL) and higher glycemic variability (0.68 day per 10 mg/dL) were associated with longer hospital length of stay. Both higher mean glucose (OR = 1.13) and higher glycemic variability (OR = 1.21) were associated with greater risks of complications. CONCLUSIONS: Poor acute phase perioperative glycemic control is associated with poor outcome, but differently in diabetic and non-diabetic patients suggesting different glycemic management strategies for the two patient groups.
BACKGROUND: The relationship between acute phase perioperative hyperglycemia and postoperative outcome is poorly understood. METHODS: Retrospective cohort study of diabetic and non-diabetic adult patients undergoing non-cardiac surgery. Mean glucose and glycemic variability during the intraoperative and immediate postoperative periods were compared to length of stay, 30-day mortality, and postoperative complications. RESULTS: . DIABETICPATIENTS (N = 1096): Higher glycemic variability was associated with longer hospital length of stay (0.32 day per 10 mg/dL) and greater 30-day mortality risk (OR = 1.42). Higher mean glucose (OR = 1.07) and glycemic variability (OR = 1.11) were associated with higher risk of complications. NON-DIABETICPATIENTS (N = 1012): Both higher mean glucose (0.29 day per 10 mg/dL) and higher glycemic variability (0.68 day per 10 mg/dL) were associated with longer hospital length of stay. Both higher mean glucose (OR = 1.13) and higher glycemic variability (OR = 1.21) were associated with greater risks of complications. CONCLUSIONS: Poor acute phase perioperative glycemic control is associated with poor outcome, but differently in diabetic and non-diabeticpatients suggesting different glycemic management strategies for the two patient groups.
Authors: John D Mannion; Assar Rather; Stephen Manifold; Kelly Gardner; Margaret McEvilly; John Yaeger; Gary Siegelman Journal: JB JS Open Access Date: 2021-08-16