Importance of Perioperative Glycemic Control in General Surgery A Report From the Surgical Care and Outcomes Assessment Program
Importance of Perioperative Glycemic Control in General Surgery A Report From the Surgical Care and Outcomes Assessment Program
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DOI：
10.1097/sla.0b013e31827b6bbc
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发表时间：
2013-01-01
影响因子：
9
通讯作者：
Flum, David
中科院分区：
文献类型：
--
作者：
Kwon, Steve;Thompson, Rachel;Flum, David
目的：确定围手术期高血糖和胰岛素给药对择期结肠/直肠和减肥手术结局的关系。背景：在接受普通外科手术的患者中，围手术期高血糖和胰岛素对不良结局的影响的证据有限，无论是否患有糖尿病。外科护理和结果评估计划是华盛顿州基于基准的质量改进计划。我们评估了围手术期高血糖的关系在2005年第四季度至2010年第四季度期间，在47家参与医院接受择期结直肠和减肥手术的患者中，研究了胰岛素（> 180 mg/dL）和胰岛素给药对死亡率、再手术干预和感染的影响。（55.4 ± 15.3岁; 65.7%的女性）在手术当天、术后第1天或术后第2天进行血清葡萄糖测定，29.1%的患者为高血糖。在控制临床因素后，高血糖症患者的感染风险显着增加[比值比（OR）2.0; 95%置信区间（CI），1.63-2.44]、再手术干预（OR，1.8; 95%CI，1.41-2.3）和死亡（OR，2.71; 95%CI，1.72-4.28）。无论有无糖尿病患者，均观察到不良结局的风险增加。接受胰岛素治疗的手术当天高血糖患者的感染（OR，1.01; 95% CI，0.72-1.42）、再次手术干预（OR，1.29; 95% CI，0.89-1.89）或死亡（OR，1.21; 95% CI，0.61-2.42）没有显著增加。胰岛素相关血糖控制（最差180-250 mg/dL，最好< 130 mg/dL）的有效性与不良结局之间存在剂量-效应关系。结论：围手术期高血糖与合并和不合并糖尿病的普外科患者的不良结局相关。然而，接受胰岛素治疗的高血糖患者的风险并不比血糖正常的患者高。围手术期血糖评估和高血糖患者的胰岛素给药是重要的质量指标。
Objective: To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations.Background: There is limited evidence to characterize the impact of perioperative hyperglycemia and insulin on adverse outcomes in patients, with and without diabetes, undergoing general surgical procedures.Methods: The Surgical Care and Outcomes Assessment Program is a Washington State quality improvement benchmarking-based initiative. We evaluated the relationship of perioperative hyperglycemia (> 180 mg/dL) and insulin administration on mortality, reoperative interventions, and infections for patients undergoing elective colorectal and bariatric surgery at 47 participating hospitals between fourth quarter of 2005 and fourth quarter of 2010.Results: Of the 11,633 patients (55.4 +/- 15.3 years; 65.7% women) with a serum glucose determination on the day of surgery, postoperative day 1, or postoperative day 2, 29.1% of patients were hyperglycemic. After controlling for clinical factors, those with hyperglycemia had a significantly increased risk of infection [ odds ratio (OR) 2.0; 95% confidence interval (CI), 1.63-2.44], reoperative interventions (OR, 1.8; 95% CI, 1.41-2.3), and death (OR, 2.71; 95% CI, 1.72-4.28). Increased risk of poor outcomes was observed both for patients with and without diabetes. Those with hyperglycemia on the day of surgery who received insulin had no significant increase in infections (OR, 1.01; 95% CI, 0.72-1.42), reoperative interventions (OR, 1.29; 95% CI, 0.89-1.89), or deaths (OR, 1.21; 95% CI, 0.61-2.42). A dose-effect relationship was found between the effectiveness of insulin-related glucose control (worst 180-250 mg/dL, best < 130 mg/dL) and adverse outcomes.Conclusions: Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than those with normal blood glucoses. Perioperative glucose evaluation and insulin administration in patients with hyperglycemia are important quality targets.