Prevalence and Clinical Outcome of Hyperglycemia in the Perioperative Period in Noncardiac Surgery

Department of Medicine, Emory University, Atlanta, Georgia, USA.
Diabetes care (Impact Factor: 8.42). 08/2010; 33(8):1783-8. DOI: 10.2337/dc10-0304
Source: PubMed


Hospital hyperglycemia, in individuals with and without diabetes, has been identified as a marker of poor clinical outcome in cardiac surgery patients. However, the impact of perioperative hyperglycemia on clinical outcome in general and noncardiac surgery patients is not known.
This was an observational study with the aim of determining the relationship between pre- and postsurgery blood glucose levels and hospital length of stay (LOS), complications, and mortality in 3,184 noncardiac surgery patients consecutively admitted to Emory University Hospital (Atlanta, GA) between 1 January 2007 and 30 June 2007.
The overall 30-day mortality was 2.3%, with nonsurvivors having significantly higher blood glucose levels before and after surgery (both P < 0.01) than survivors. Perioperative hyperglycemia was associated with increased hospital and intensive care unit LOS (P < 0.001) as well as higher numbers of postoperative cases of pneumonia (P < 0.001), systemic blood infection (P < 0.001), urinary tract infection (P < 0.001), acute renal failure (P = 0.005), and acute myocardial infarction (P = 0.005). In multivariate analysis (adjusted for age, sex, race, and surgery severity), the risk of death increased in proportion to perioperative glucose levels; however, this association was significant only for patients without a history of diabetes (P = 0.008) compared with patients with known diabetes (P = 0.748).
Perioperative hyperglycemia is associated with increased LOS, hospital complications, and mortality after noncardiac general surgery. Randomized controlled trials are needed to determine whether perioperative diabetes management improves clinical outcome in noncardiac surgery patients.

Download full-text


Available from: Monica Rizzo,
  • Source
    • "Obesity, diabetes, and hepatic steatosis often coexist in the metabolic syndrome [25], and the increased risk of operating in the presence of steatosis may be due to associated comorbidity. Diabetes mellitus and obesity are independent risk factors for postoperative complications following other types of major surgery, including infectious [26] [27] [28], cardiovascular [28] [29], and renal complications [26] [28] [29]. Furthermore in the four studies included in the meta-analysis heterogeneous definitions of postoperative complications were used, and often relatively minor complications were included. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. This study aimed to assess the relationship between diabetes, obesity, and hepatic steatosis in patients undergoing liver resection and to determine if these factors are independent predictors of major complications. Materials and Methods. Analysis of a prospectively maintained database of patients undergoing liver resection between 2005 and 2012 was undertaken. Background liver was assessed for steatosis and classified as <33% and ≥33%. Major complications were defined as Grade III-V complications using the Dindo-Clavien classification. Results. 504 patients underwent liver resection, of whom 56 had diabetes and 61 had steatosis ≥33%. Median BMI was 26 kg/m(2) (16-54 kg/m(2)). 94 patients developed a major complication (18.7%). BMI ≥ 25 kg/m(2) (P = 0.001) and diabetes (P = 0.018) were associated with steatosis ≥33%. Only insulin dependent diabetes was a risk factor for major complications (P = 0.028). Age, male gender, hypoalbuminaemia, synchronous bowel procedures, extent of resection, and blood transfusion were also independent risk factors. Conclusions. Liver surgery in the presence of steatosis, elevated BMI, and non-insulin dependent diabetes is not associated with major complications. Although diabetes requiring insulin therapy was a significant risk factor, the major risk factors relate to technical aspects of surgery, particularly synchronous bowel procedures.
    HPB Surgery 08/2014; 2014:586159. DOI:10.1155/2014/586159
  • Source
    • "Elevated blood glucose levels pre and postoperatively have been shown to be associated with poor outcomes in surgical patients.6 The outcomes are worst in those people with hyperglycaemia, but not known to have a previous diagnosis of diabetes.6,7 "
    [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of diabetes mellitus is increasing. Previous work has shown that suboptimal glycaemic control is associated with poor perioperative outcomes with increased rates of postoperative morbidity and mortality in several surgical specialities. Recently published UK guidelines have laid out the standards of perioperative care for patients with diabetes. Because an increasing number of patients with diabetes undergo surgery, it is important that these nationally agreed standards of care are adhered to.
    02/2014; 5(2):2042533313515864. DOI:10.1177/2042533313515864
  • Source
    • "Diabetes mellitus, a highly prevalent disease characterized by sustained hyperglycemia and chronic complications, leads to considerable morbidity and mortality (1). In the course of the disease, patients often need to be hospitalized because of infections, acute coronary syndrome, percutaneous/surgical coronary revascularization, stroke, or complications of peripheral vascular disease, which are frequently accompanied by worsening hyperglycemia, a predictor of poor outcomes (e.g., prolonged hospital stay, disability after hospital discharge, and death) (2,3). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the effectiveness of healthcare team guidance in the implementation of a glycemic control protocol in the non-intensive care unit of a cardiology hospital. This was a randomized clinical trial comparing 9 months of intensive guidance by a healthcare team on a protocol for diabetes care (Intervention Group, n = 95) with 9 months of standard care (Control Group, n = 87). NCT01154413. The mean age of the patients was 61.7±10 years, and the mean glycated hemoglobin level was 71±23 mmol/mol (8.7±2.1%). The mean capillary glycemia during hospitalization was similar between the groups (9.8±2.9 and 9.1±2.4 mmol/l for the Intervention Group and Control Group, respectively, p = 0.078). The number of hypoglycemic episodes (p = 0.77), hyperglycemic episodes (47 vs. 50 in the Intervention Group and Control Group, p = 0.35, respectively), and the length of stay in the hospital were similar between the groups (p = 0.64). The amount of regular insulin administered was 0 (0-10) IU in the Intervention Group and 28 (7-56) IU in the Control Group (p<0.001), and the amount of NPH insulin administered was similar between the groups (p = 0.16). While guidance on a glycemic control protocol given by a healthcare team resulted in a modification of the therapeutic strategy, no changes in glycemic control, frequency of episodes of hypoglycemia and hyperglycemia, or hospitalization duration were observed.
    Clinics (São Paulo, Brazil) 11/2013; 68(11):1400-1407. DOI:10.6061/clinics/2013(11)03 · 1.19 Impact Factor
Show more