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The Clinical Significance Of An Elevated Postoperative Glucose Value In Non-diabetic Patients After Colorectal Surgery: Evidence For The Need For Tight Glucose Control?
Ravi P Kiran*, Matthias Turina*, Jeff Hammel*, Victor W Fazio
Cleveland Clinic Foundation, Cleveland, OH

Objective: To evaluate the significance of hyperglycemia in patients without a preoperative diagnosis of diabetes undergoing elective colorectal surgery.
Methods: Preoperative and all postoperative blood glucose measurements were retrieved for 2628 consecutive patients undergoing elective colorectal resection over 2 years at one center. Non-diabetic patients were identified as those without a preoperative diagnosis of diabetes and/or based on HbA1C levels. The association between any elevated postoperative random glucose value (hyperglycemia: >125mg/dL) and level of elevation (>125 mg/dl or >200mg/dl) within 72 hours of surgery in non-diabetic patients with 30-day mortality, infectious and non-infectious complications was assessed.
Results: Evaluation of 16,404 postoperative glucose measurements for all 2447 non-diabetic patients who underwent surgery in 2010 and 2011 revealed 66.7% patients experienced hyperglycemia. Degree of hyperglycemia correlated with increasing ASA class and surgical severity (blood loss). Hyperglycemia was associated with infectious and non-infectious complications and mortality, the rates of these complications increasing parallel to the degree of hyperglycemia (Table). Hyperglycemia was independently associated with septic complications (p=0.024).
Conclusions: Postoperative hyperglycemia is frequent after elective colorectal surgery in non-diabetic patients. Even a single postoperative elevated glucose value is adversely associated with morbidity and mortality, this risk related to the degree of glucose elevation. These findings strongly support monitoring of glucose values and early consideration of management strategies for glycemic control after surgery even in non-diabetic patients.


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