Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries

Epidemiology/Health Services Research

¹Department of Statistical Science, Duke University, Durham, NC
²Department of Anesthesiology, Duke University School of Medicine, Durham, NC
³Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, NC
⁴Department of Neurobiology, Duke University School of Medicine, Durham, NC

Diabetes Care 2018 Apr; 41(4): 782-788. https://doi.org/10.2337/dc17-2232

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Figure 1
Case inclusion flow chart. Visual representation of how the 6,684 noncardiac and 6,393 cardiac cases analyzed were selected from the 431,480 surgical procedures available.
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Figure 2
Average perioperative glucose level versus preoperative A1C percentage. Visual summary of the association between preoperative A1C and the average of glucose from the day of surgery through postoperative day 2 from the generalized additive model fit on the 6,684 noncardiac (left) and 6,393 cardiac surgeries (right). The solid line is the mean prediction and the dashed lines the 95% CIs.
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Figure 3
Probability of postoperative mortality (Pr. of postop. mort.) versus A1C, glucose, age, and BMI. Visual summary of the associations between 30-day postoperative mortality and preoperative A1C, average of glucose measurements from day of surgery up to postoperative day 2, age, and BMI from the generalized additive logistic model fit on the 6,684 noncardiac (left) and 6,393 cardiac surgeries (right). The solid line is the estimated probability and the dashed lines the 95% CIs.

Table 1

Demographic and clinical characteristics

Characteristic	Mean or n (%)	SD	Quartiles
Characteristic	Mean or n (%)	SD	Q1	Median	Q3
Data set: 167,376 noncardiac procedures not constrained by having preoperative A1C and perioperative glucose measured or by procedure type
Age (years)	53	18	39	55	67
BMI	29	6.6	24	28	32
30-day postoperative mortality	1,456 (0.9%)
Female	96,873 (58%)
Data set: 6,684 noncardiac procedures constrained by having preoperative A1C and perioperative glucose measured and being among 199 types considered
Age (years)	60	15	50	62	71
BMI	32	7.7	26	30	36
30-day postoperative mortality	156 (2.3%)
Female	3,518 (53%)
Average perioperative glucose (mg/dL)	149	42	118	142	172
No. of perioperative glucose measurements	11	11	2	8	15
A1C (%\|mmol/mol)	7.1\|54	1.7\|19	5.9\|41	6.6\|49	7.8\|62
Data set: 12,199 cardiac procedures not constrained by having preoperative A1C and perioperative glucose measured or by procedure type
Age	62	14	54	63	72
BMI	29	6.0	25	28	32
30-day postoperative mortality	273 (2.2%)
Female	4,557 (37%)
Data set: 6,393 cardiac procedures constrained by having preoperative A1C and perioperative glucose measured and being among 9 types considered
Age	64	12	56	65	73
BMI	29	6.0	25	28	32
30-day postoperative mortality	116 (1.8%)
Female	2,257 (35%)
Average perioperative glucose (mg/dL)	146	19	134	145	156
No. of perioperative glucose measurements	32	13	24	33	42
A1C (%\|mmol/mol)	6.4\|46	1.4\|15	5.6\|38	6.0\|42	6.7\|50

Summary statistics of demographic and clinical characteristics for the cardiac and noncardiac sets of surgeries not constrained and constrained by having both preoperative A1C and perioperative glucose measured and by being one of the procedure types considered.