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Perioperative Hyperglycemia Increases Risk of Poor Outcomes in Nondiabetics


 

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

Background: Perioperative 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 perioperative adverse events overall compared to nondiabetics (12% versus 9%, P<0.001). Perioperative 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 (odds ratio, 1.6; 95% CI, 1.3–2.1) than in diabetic patients (odds ratio, 0.8; 95% CI, 0.6–1.0). Although the exact reason for this is unknown, existing theories include the following:

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

Bottom line: Perioperative 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. TH

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