Hyperglycemia Is Associated with Increased Risk of Morbidity and Mortality after Colectomy for Cancer - 21/12/11
Correspondence address: Robyn A Macsata, MD, Department of Surgery, VA Medical Center, 50 Irving St NW, Washington, DC 20010Résumé |
Background |
The relationship of hyperglycemia to general surgery outcomes is not well-understood. We studied the association of operative day and postoperative day 1 (POD1) blood glucose (BG) with outcomes after open colectomy for cancer.
Study Design |
We retrospectively analyzed the 2000-2005 Veterans Affairs Surgical Quality Improvement Program database, linked with Veterans Affairs Decision Support System BG values. Median BG was categorized as hypoglycemic (<80 mg/dL); normoglycemic (BG 80−120 mg/dL); or mildly (BG 121−160 mg/dL), moderately (BG 161−200 mg/dL), or severely (BG >200 mg/dL) hyperglycemic. The relationship of BG to postoperative outcomes was assessed with multivariable logistic regression.
Results |
We identified 9,638 colectomies. We excluded 511 procedures for emergency status or preoperative coma, mechanical ventilation, or sepsis. After excluding patients without recorded BG, we analyzed operative day and POD1 BG in 7,576 and 5,773 procedures, respectively. On multivariable analysis, operative day moderate hyperglycemia was associated with surgical site infection (odds ratio = 1.44; 95% CI, 1.10−1.87). POD1 severe hyperglycemia was associated with cardiac arrest (odds ratio = 2.31; 95% CI, 1.08−4.98) and death (odds ratio = 1.97; 95% CI, 1.23−3.15). POD1 mild (odds ratio = 2.20; 95% CI, 1.05−4.60), moderate (odds ratio = 3.44; 95% CI, 1.51−7.84), and severe (odds ratio = 3.94; 95% CI, 1.64−9.58) hyperglycemia and hypoglycemia (odds ratio = 6.74; 95% CI, 1.75−25.97) were associated with myocardial infarction. Associations were similar in diabetic and nondiabetic patients.
Conclusions |
Even mild hyperglycemia was associated with adverse outcomes after colectomy, suggesting that a perioperative BG target of 80 to 120 mg/dL, although avoiding hypoglycemia, might be appropriate. Randomized clinical trials are needed to confirm these findings.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : BG, MICU, OD, POD1, SICU, SSI, UTI, VA, VASQIP, VTE
Plan
| Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. |
|
| This article represents the personal viewpoint of the authors and cannot be construed as a statement of official Department of Veterans Affairs or United States Government policy. |
Vol 214 - N° 1
P. 68-80 - janvier 2012 Retour au numéro
Article précédent
- Systematic Immunohistochemistry Screening for Lynch Syndrome in Early Age-of-Onset Colorectal Cancer Patients Undergoing Surgical Resection
- Emily Steinhagen, Jinru Shia, Arnold J. Markowitz, Zsofia K. Stadler, Erin E. Salo-Mullen, Junting Zheng, Steven A. Lee-Kong, Garrett M. Nash, Kenneth Offit, José G. Guillem
- Who Receives Their Complex Cancer Surgery at Low-Volume Hospitals?
- Waddah B. Al-Refaie, Binyam Muluneh, Wei Zhong, Helen M. Parsons, Todd M. Tuttle, Selwyn M. Vickers, Elizabeth B. Habermann
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?