Abstract

Background. Hospital hyperglycemia, in patients with and without diabetes has been identified as a marker of poor clinical outcome in cardiac surgery patients. It is not known; however, what is the impact of perioperative hyperglycemia on clinical outcome in general and noncardiac surgical patients.

Methods. This observational study aimed to determine the relationship between pre- and post-surgery blood glucose levels and hospital length of stay (LOS), complications and mortality in 3,184 noncardiac surgical patients consecutively admitted to Emory University Hospital, Atlanta, GA between 1/1/07 and 6/30/07.

Results. The overall 30-day mortality was 2.3%, with nonsurvivors having significantly higher blood glucose levels prior to and after surgery (both, p<0.01) than survivors. Perioperative hyperglycemia was associated with increased hospital and ICU LOS (p<0.001) as well as higher 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, gender, race, 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 to patients with known diabetes (p= 0.748).

Conclusion. Perioperative hyperglycemia is associated with increased length of stay, hospital complications and mortality after noncardiac general surgery. Randomized controlled trials are needed to determine if perioperative diabetes management improves clinical outcome in noncardiac surgical patients.