Association between acute phase perioperative glucose parameters and postoperative outcomes in diabetic and non-diabetic patients undergoing non-cardiac surgery.

ABSTRACT

BACKGROUND: The relationship between acute phase perioperative hyperglycemia and postoperative outcome is poorly understood. METHODS: Retrospective cohort study of diabetic and non-diabetic adult patients undergoing non-cardiac surgery. Mean glucose and glycemic variability during the intraoperative and immediate postoperative periods were compared to length of stay, 30-day mortality, and postoperative complications. RESULTS: . DIABETIC PATIENTS (N = 1096) Higher glycemic variability was associated with longer hospital length of stay (0.32 day per 10 mg/dL) and greater 30-day mortality risk (OR = 1.42). Higher mean glucose (OR = 1.07) and glycemic variability (OR = 1.11) were associated with higher risk of complications. NON-DIABETIC PATIENTS (N = 1012) Both higher mean glucose (0.29 day per 10 mg/dL) and higher glycemic variability (0.68 day per 10 mg/dL) were associated with longer hospital length of stay. Both higher mean glucose (OR = 1.13) and higher glycemic variability (OR = 1.21) were associated with greater risks of complications. CONCLUSIONS: Poor acute phase perioperative glycemic control is associated with poor outcome, but differently in diabetic and non-diabetic patients suggesting different glycemic management strategies for the two patient groups.