Topic: C. Clinical GI
Perioperative hyperglycemia in noncardiac surgical patients: Does it increase postoperative infections?
Selwyn O Rogers, Jr., Margarita Ramos, Zain Khalpey, Jill Steinberg, Maria Panizales, Stuart Lipsitz, Michael J. Zinner
Brigham and Women's Hospital, Boston, MA
OBJECTIVE(S): Evaluate the association between perioperative glucose levels and postoperative infections in noncardiac surgery patients.
METHODS: A 2-year retrospective, observational study using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was evaluated. 991 patients underwent major noncardiac surgery, 13% of whom were diabetic. Our outcome was postoperative infectious complications (pneumonia, wound infections, urinary tract infections, and sepsis) within 30 days of surgery. The primary predictor of interest was postoperative glucose (POG) (<118, 118-150, 150-180 and >180, mg/dL). We determined (bivariate analyses) the association of independent variables (POG, age, race, diabetic status, American Society of Anesthesiologists classification (ASA), elective vs. emergent procedure, operation length, amount of blood transfused) with outcome. Factors significant at p<0.05 were used in a multivariable logistic regression model.
RESULTS: Bivariate analyses revealed POG (p=0.04), age (p<0.001), diabetes (p=0.01), ASA (p<0.0001), operation length (p=0.04), and amount of blood transfused (p=0.002) were significantly associated with postoperative infectious outcomes, while pre-operative glucose (p=0.384) and race (p=0.831) were not. The incidence of postoperative infections for diabetic and non-diabetic patients was15.3% and 8.8%, respectively. In multivariate analyses, POG levels >180 mg/dL (p=0.0423, adjusted OR=2.03, 95% C.I., 1.03-4.03) and ASA (p=0.0004) remained the only significant predictors of postoperative infections.
CONCLUSIONS: Postoperative hyperglycemia increases the risk of 30-day postoperative infections in a heterogeneous group of noncardiac surgery patients, independent of preoperative glucose levels or diabetic status. Stringent glycemic control (<180 mg/dL) in this patient population appears to decrease the risk of postoperative infections in the immediate postoperative period.