Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery.
ABSTRACT To determine the relationship between preoperative glucose levels and perioperative mortality in noncardiac, nonvascular surgery.
We performed a case-control study in a cohort of 108 593 patients who underwent noncardiac surgery at the Erasmus MC during 1991-2001. Cases were 989 patients who underwent elective noncardiac, nonvascular surgery and died within 30 days during hospital stay. From the remaining patients, 1879 matched controls (age, sex, calendar year, and type of surgery) were selected. Information was obtained regarding the presence of cardiac risk factors, medication, and preoperative laboratory results. Preoperative random glucose levels <5.6 mmol/l (110 mg/dl) were normal. Impaired glucose levels in the range of 5.6-11.1 mmol/l were prediabetes. Glucose levels >or=11.1 mmol/l (200 mg/dl) were diabetes.
Preoperative glucose levels were available in 904 cases and 1247 controls. A cardiovascular complication was the primary cause of death in 207 (23%) cases. Prediabetes glucose levels were associated with a 1.7-fold increased mortality risk compared with normoglycemic levels (adjusted odds ratio (OR) 1.7 and 95% confidence interval (CI) 1.4-2.1; P<0.001). Diabetes glucose levels were associated with a 2.1-fold increased risk (adjusted OR 2.1 and 95% CI 1.3-3.5; P<0.001). In cases with cardiovascular death, prediabetes glucose levels had a threefold increased cardiovascular mortality risk (adjusted OR 3.0 and 95% CI 1.7-5.1) and diabetes glucose levels had a fourfold increased cardiovascular mortality risk (OR 4.0 and 95% CI 1.3-12).
Preoperative hyperglycemia is associated with increased (cardiovascular) mortality in patients undergoing noncardiac, nonvascular surgery.
Full-textDOI: · Available from: Miklos D Kertai, May 26, 2015
SourceAvailable from: Naohiro Shibuya[Show abstract] [Hide abstract]
ABSTRACT: Abstract BACKGROUND: The relationship between hyperglycemia and adverse outcomes following surgery has been widely documented. Long-term glucose control has been recognized as a risk factor for postoperative complications. In the foot and ankle literature, long-term glycemic control as a potential perioperative risk factor is not well studied. Our goal was to investigate if hemoglobin A1c (HbA1c) was independently associated with postoperative complications in a retrospective cohort study.Journal of the American Podiatric Medical Association 06/2014; DOI:10.7547/13-026.1 · 0.57 Impact Factor
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ABSTRACT: Background and objective The management of hyperglycemia in conventional wards is suboptimal. The objective of our study was to evaluate the efficacy of a proactive intervention supported by point-of-care system with remote viewing of capillary blood glucose (CBG) on glycemic control as compared to usual care in non-critical surgical patients. Patients and method Two sequential periods of 2 months were defined. In the first phase (control, CPh), in which the surgical team was in charge of glycemic control, capillary glucose levels were recorded by StatStrip® system, and endocrinological support was provided upon surgeons request. In a second phase (intervention, IPh), the endocrinologist proceeded based on remotely-viewed CBG values. We compared the use of basal-bolus therapy and the degree of glycemic control between the 2 study periods. Results The IPh was associated with greater use of basal-bolus regimens (21.4 vs. 58.3%; P = .003). The average CBG during the CPh was 161 ± 64 vs. 142 ± 48 mg/dL during the IPh (P < .001). The IPh was associated with an increased frequency of CBG determinations between 70-140 mg/dL (CPh: 41.8 vs. IPh: 52.5%; P < .001), lower frequency of ≥ 250 mg/dL CBG determinations (CPh: 9 vs. IPh: 3.5%; P < .001), with no increase in the frequency of hypoglycemia (CPh: 3 vs. IPh: 3.7%; P = .39). Conclusions A proactive endocrine intervention facilitated by a point-of-care system with remote viewing of CBG is associated with improved glycemic control in non-critical patients, without any further increase in the number of hypoglycaemic recordings.Medicina Clínica 05/2014; 142(9):387–392. DOI:10.1016/j.medcli.2013.01.037 · 1.25 Impact Factor
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ABSTRACT: Appropriate management of diabetes mellitus before a procedure or operation is important for the prevention of hypo- and hyperglycemia in the periprocedural/perioperative period. This can significantly influence glucose levels after a procedure, which in turn affects outcomes. There is a paucity of prospective trials addressing algorithms to guide adjustment of oral diabetes medications and insulin prior to a procedure. Our institution has developed guidelines that allowed us to standardize the periprocedural process for glucose management across departments. This article describes our experience with guidelines, discusses salient features of medication management, and summarizes prospective trials and expert opinion to provide recommendations for clinicians to effectively manage glucose preprocedurally for their patients with diabetes.Postgraduate Medicine 10/2014; 126(6):73-80. DOI:10.3810/pgm.2014.10.2822 · 1.54 Impact Factor