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

Anna Frisch; Prakash Chandra; Dawn Smiley; Limin Peng; Monica Rizzo; Chelsea Gatcliffe; Megan Hudson; Jose Mendoza; Rachel Johnson; Erica Lin; Guillermo E. Umpierrez

doi:10.2337/dc10-0304

Original Research

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

Anna Frisch, PHD, MD¹,
Prakash Chandra, MD, MS¹,
Dawn Smiley, MD¹,
Limin Peng, PHD²,
Monica Rizzo, MD³,
Chelsea Gatcliffe, BS¹,
Megan Hudson, BS¹,
Jose Mendoza, BS¹,
Rachel Johnson, BS¹,
Erica Lin, BS¹ and
Guillermo E. Umpierrez, MD¹

¹Department of Medicine, Emory University, Atlanta, Georgia;
²Rollins School of Public Health, Emory University, Atlanta, Georgia;
³Department of Surgery, Emory University, Atlanta, Georgia.

Corresponding author: Guillermo E. Umpierrez, geumpie{at}emory.edu.

Diabetes Care 2010 Aug; 33(8): 1783-1788. https://doi.org/10.2337/dc10-0304

Abstract

OBJECTIVE 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.

RESEARCH DESIGN AND METHODS 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.

RESULTS 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).

CONCLUSIONS 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.

Footnotes

Clinical trial registry no. NCT00738114, clinicaltrials.gov.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

View Full Text