Abstract

IntroductionTreating hyperglycaemia in hospitalized patients has proven to be beneficial, particularly in those with obstructive vascular disease. In a cohort of patients undergoing resection for oesophageal carcinoma (a group of patients with severe surgical stress but a low prevalence of vascular disease), we investigated whether early postoperative hyperglycaemia is associated with increased incidence of infectious complications and prolonged in-hospital stay.MethodsPostoperative glucose values up to 48 hours after surgery were retrieved for 151 patients with American Society of Anesthesiologists class I or II who had been previously included in a randomized trial conducted in a tertiary referral hospital. Multivariate regression analysis was used to define the independent contribution of possible risk factors selected by univariate analysis.ResultsIn univariate regression analysis, postoperative glucose levels were associated with increased length of in-hospital stay (P < 0.001) but not with infectious complications (P = 0.21). However, postoperative glucose concentration was not found to be an independent risk factor for prolonged in-hospital stay in multivariate analysis (P = 0.20).ConclusionOur data indicate that postoperative hyperglycaemia is more likely to be a risk marker than a risk factor in patients undergoing highly invasive surgery for oesophageal cancer. We hypothesize that patients with a low prevalence of vascular disease may benefit less from intensive insulin therapy.

Highlights

  • Treating hyperglycaemia in hospitalized patients has proven to be beneficial, in those with obstructive vascular disease

  • In a landmark study, van den Berghe and coworkers [1] showed that treating transient postoperative hyperglycaemia with intensive insulin therapy in a surgical intensive care unit (ICU) dramatically reduces mortality and morbidity

  • We investigated whether postoperative hyperglycaemia is a risk factor for postoperative infections and prolonged in-hospital stay in a cohort of patients undergoing resection for adenocarcinoma of the oesophagus

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Summary

Introduction

Treating hyperglycaemia in hospitalized patients has proven to be beneficial, in those with obstructive vascular disease. In a landmark study, van den Berghe and coworkers [1] showed that treating transient postoperative hyperglycaemia with intensive insulin therapy in a surgical intensive care unit (ICU) dramatically reduces mortality and morbidity. The population studied by van den Berghe and coworkers was diverse but consisted primarily of patients who underwent cardiac surgery (63%). Others have found beneficial effects of intensive insulin therapy in patients with obstructive vascular disease such as acute myocardial infarction and acute stroke, and in those who have undergone cardiovascular bypass surgery [2,3,4,5,6,7]. It is important to determine which patient groups in the ICU are likely to benefit most or least from aggressively correcting hyperglycaemia

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