Immediate preoperative hyperglycemia correlates with complications in non-cardiac surgical cases.
Immediate preoperative hyperglycemia correlates with complications in non-cardiac surgical cases.
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DOI：
10.1016/j.jclinane.2021.110375
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发表时间：
2021-11
影响因子：
6.7
通讯作者：
O'Neill BT
中科院分区：
文献类型：
--
作者：
Dougherty SM;Schommer J;Salinas JL;Zilles B;Belding-Schmitt M;Rogers WK;Shibli-Rahhal A;O'Neill BT
评估术前血糖浓度与术后并发症之间的关系。回顾性队列研究。单一大型三级护理学术医疗中心。我们医院所有患者的五年登记，这些患者在非紧急手术前 6 小时测量了葡萄糖浓度（血浆、血清或静脉/毛细血管/动脉全血）。葡萄糖登记与美国外科医生学会国家手术质量改进计划 (ACS NSQIP) 的数据库进行了交叉引用。我们对从两个登记处获得数据的患者子集（n = 1774）进行了结果审查。使用 1) 单变量分析和 2) 完整多变量分析校正 ACS NSQIP 数据库中提供的 27 个临床因素，将整个人群以及患有或不患有糖尿病的患者亚组的术前血糖浓度与不良术后结果相关。根据以下分类，使用血糖水平作为连续变量或分类变量进行逻辑回归分析：轻度（≥140 mg/dL；≥7.8 mmol/L）、中度（≥180 mg/dL；≥10 mmol/L）或重度（≥250 mg/dL；≥13.9 mmol/L）高血糖。第三次分析对 7 个临床重要因素（年龄、BMI、预计手术时间、性别、CKD 分期、低蛋白血症和糖尿病状态）进行了校正，这些因素被麻醉师和外科医生确定为可立即使用且对决策很重要。对所有患者以及非糖尿病或糖尿病患者亚组的单变量分析表明，术前轻度或中度高血糖与术后并发症相关。使用完整的多变量分析，大多数组的统计显着性都丢失了，但在校正术前立即可用的 7 个因素时却没有丢失统计显着性。然而，对于所有糖尿病患者来说，即使在完整的多变量分析中，中度高血糖（≥180 mg/dL；≥10 mmol/L）仍然与并发症显着相关[优势比（OR）1.79； 95% 置信区间 (CI) 1.10, 2.92]，并且在 30 天内重新入院/再次手术 [OR 1.93； 95% CI 1.18, 3.13]。手术后 6 小时内术前高血糖是术后不良结果的标志。在我们研究的糖尿病患者中，术前血糖水平≥180mg/dL（≥10mmol/L）与术后并发症和再入院/再次手术的风险独立相关。这些结果应该鼓励未来的工作，以确定立即解决术前高血糖是否可以提高并发症发生率，或者只是作为高风险的标志。
Assess for a relationship between immediate preoperative glucose concentrations and postoperative complications. Retrospective cohort study. Single large, tertiary care academic medical center. A five-year registry of all patients at our hospital who had a glucose concentration (plasma, serum, or venous/capillary/arterial whole blood) measured up to 6 h prior to a non-emergent surgery. The glucose registry was cross-referenced with a database from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We applied an outcomes review to the subset of patients for whom we had data from both registries (n = 1774). Preoperative glucose concentration in the full population as well as the subgroups of patients with or without diabetes were correlated with adverse postsurgical outcomes using 1) univariable analysis and 2) full multivariable analysis correcting for 27 clinical factors available from the ACS NSQIP database. Logistic regression analysis was performed using glucose level either as a continuous variable or as a categorical variable according to the following classifications: mild (≥140 mg/dL; ≥7.8 mmol/L), moderate (≥180 mg/dL; ≥10 mmol/L), or severe (≥250 mg/dL; ≥13.9 mmol/L) hyperglycemia. A third analysis was performed correcting for 7 clinically important factors (age, BMI, predicted duration of procedure, sex, CKD stage, hypoalbuminemia, and diabetic status) identified by anesthesiologists and surgeons as immediately available and important for decision making. Univariable analysis of all patients and the subgroups of patients without diabetes or with diabetes showed that immediate preoperative mild or moderate hyperglycemia correlates with postoperative complications. Statistical significance was lost in most groups using full multivariable analysis, but not when correcting for the 7 factors available immediately preoperatively. However, for all patients with diabetes, moderate hyperglycemia (≥180 mg/dL; ≥10 mmol/L) continued to significantly correlate with complications even in the full multivariable analysis [odds ratio (OR) 1.79; 95% Confidence Intervals (CI) 1.10, 2.92], and with readmission/reoperation within 30 days [OR 1.93; 95% CI 1.18, 3.13]. Preoperative hyperglycemia within 6 h of surgery is a marker of adverse postoperative outcomes. Among patients with diabetes in our study, a preoperative glucose level ≥ 180 mg/dL (≥10 mmol/L) independently correlates with risk of postoperative complications and readmission/reoperation. These results should encourage future work to determine whether addressing immediate preoperative hyperglycemia can improve complication rates, or simply serves as a marker of higher risk.
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影响因子：
5.7
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通讯作者：
Flum, David