Patient Care

Peri-Operative Hyperglycemia and Risk of Adverse Events in Diabetic Patients


 

Clinical question: How does peri-operative hyperglycemia affect the risk of adverse events in diabetic patients compared to nondiabetic patients?

Background: Peri-operative hyperglycemia is associated with increased rates of infection, myocardial infarction, stroke, and death. Recent studies suggest that nondiabetics are more prone to hyperglycemia-related complications than diabetics. This study sought to analyze the effect and mechanism by which nondiabetics may be at increased risk for such complications.

Study Design: Retrospective cohort study.

Setting: Fifty-three hospitals in Washington.

Synopsis: Among 40,836 patients who underwent surgery, diabetics had a higher rate of peri-operative adverse events overall compared to nondiabetics (12% vs. 9%, P<0.001). Peri-operative hyperglycemia, defined as blood glucose 180 or greater, was also associated with an increased rate of adverse events. Ironically, this association was more significant in nondiabetic patients [OR 1.6; 95% CI, 1.3-2.1] than in diabetic patients (OR, 0.8; 95% CI, 0.6-1.0). Although the exact reason for this is unknown, existing theories include the following:

  1. Diabetics are more apt to receive insulin for peri-operative hyperglycemia than nondiabetics (P<0.001);
  2. Hyperglycemia in diabetics may be a less reliable marker of surgical stress than in nondiabetics; and
  3. Diabetics may be better adapted to hyperglycemia than nondiabetics.

Bottom Line: Peri-operative hyperglycemia leads to an increased risk of adverse events; this relationship is more pronounced in nondiabetic patients than in diabetic patients.

Citation: Kotagal M, Symons RG, Hirsch IB, et al. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg. 2015;261(1):97-103.

Short takes

COCHRANE REVIEW OF RANDOMIZED CONTROLLED TRIALS EVALUATING THE EPLEY MANEUVER VERSUS PLACEBO, NO TREATMENT, OR OTHER ACTIVE TREATMENT FOR ADULTS DIAGNOSED WITH POSTERIOR CANAL BPPV

Benign paroxysmal positional vertigo (BPPV) can effectively be diagnosed and treated using the Epley maneuver. There do not appear to be serious adverse effects.

Citation: Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014;12:CD003162


HOSPITAL-ACQUIRED INFECTIONS (HAIs) DROPPING, BUT STILL MORE ROOM TO GO

A CDC report reveals an overall decrease in HAIs at the national and state level between 2008 and 2013. Nationally, central-line associated bloodstream infection has dropped 46%; catheter-associated urinary tract infection has modestly increased.

Citation: Centers for Disease Control and Prevention. Healthcare-Associated Infections Progress Report. January 14, 2015. Available at: www.cdc.gov/hai/progress-report/index.html. Accessed March 10, 2015.

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