Perioperative hyperglycemia is an established risk factor associated with surgical complications and has been traditionally associated with the diagnosis of diabetes; however, researchers have found that individuals without diabetes who experience similar hyperglycemic excursions have even a greater risk of complications when compared to their counterparts with the disease. The results of the research were published in the Journal of the American Medical Association Surgery.
First author Judy Y. Chen, MD, with the Department of Surgery at the University of Washington in Seattle, and colleagues, investigated whether there is an association between perioperative hyperglycemia and surgical complications in all patients and, if so, what are the potential consequences of not identifying perioperative hyperglycemia in these individuals. In the study findings, the researchers concluded that patients without diabetes paradoxically had worse outcomes than patients with diabetes at similar levels of hyperglycemia and that the "broader use" of insulin may decrease this effect and improve outcomes.
The retrospective, cohort study evaluated consecutive patients undergoing surgery who were admitted for at least 48 hours. The authors reported that there was an adjusted odds of experiencing any type of postoperative complication and was consistently higher for patients without diabetes than those with diabetes. More specifically, 83% greater for patients without versus with diabetes at a blood glucose level of 140-179 mg/dL (odds ratio, 1.83 [95% CI, 0.93-3.6]); 49% greater for a blood glucose level of 180 to 249 mg/dL (odds ratio, 1.49 [95% CI, 1.06-2.11]); and 88% greater for a blood glucose level more than 250 mg/dL (odds ratio, 1.88 [95% CI, 1.11-3.17].
The authors also reported, "A total of 7,634 patients (mean [SD] age, 53.5 [15.1] years; 6,664 patients without diabetes [83.3%] and 970 patients with diabetes [17.7%]) underwent general (6204 [81.3%]), vascular (208 [2.7%]), and gynecologic (1222 [16%]) operations. Of these, 5,868 (77%) had blood glucose testing (4,899 individuals with diabetes [73.5%] and 969 [99.9%] without diabetes). Hyperglycemia occurred in 882 patients with diabetes (91%) and 2484 patients without diabetes (50.7%). Of those with blood glucose level more than 180 mg/dL, 1388 (72.7%) received insulin (658 patients with diabetes who had hyperglycemia [91%] and 680 patients without diabetes who had hyperglycemia [61%])."
The team used multivariate regression to estimate the association of complications and hyperglycemia, with stratification by the severity of hyperglycemia and after adjusting for the diagnosis of diabetes.
Dr. Chen and colleagues underscored that the previous benchmark, which considered surgical complications more likely in diabetic patients experiencing perioperative hyperglycemia, should be reconsidered in light of their recent findings demonstrating that patients without diabetes are actually at greater risk of complications even at similar levels of hyperglycemia.
According to Dr. Chen, "Because neither underuse of insulin nor diabetes misclassification was responsible for perioperative hyperglycemia, consideration of the possibility of a biological mechanism should be made."
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