Abstract
Background: Hyperglycemia in surgical candidates is associated with increased mortality and morbidity. We aimed to evaluate the effect of intraoperative blood glucose level on the incidence of myocardial injury after non-cardiac surgery (MINS) in diabetic patients. Methods: Diabetic patients with available intraoperative blood glucose measurement during non-cardiac surgery were enrolled in this study. Based on the highest intraoperative blood glucose level, patients were stratified into two groups: the blood sugar glucose (BST) < 180 group (intraoperative peak glucose < 180 mg/dL) and BST ≥ 180 group (intraoperative peak glucose ≥ 180 mg/dL). The primary outcome was the incidence of MINS, and secondary outcomes were in-hospital and 30-day mortalities. Results: Of the 11,302 diabetic patients, 8337 were in the BST < 180 group (73.8%) and 2965 in the BST ≥ 180 group (26.2%). After adjustment with inverse probability weighting, MINS was significantly higher in the BST ≥ 180 group (24.0% vs. 17.2%; odds ratio (OR), 1.26; 95% confidence interval (CI), 1.14–1.40; p < 0.001). In addition, in-hospital and 30-day mortalities were also higher in the BST ≥ 180 group compared to the BST < 180 group (4.2% vs. 2.3%, hazard ratio (HR), 1.39; 95% CI, 1.07–1.81; p = 0.001, and 3.1% vs. 1.8%; HR, 1.76; 95% CI, 1.31–2.36; p < 0.001, respectively). Receiver-operating characteristic plots showed that the threshold of glucose level associated with MINS was 149 mg/dL. Conclusion: Intraoperative hyperglycemia was associated with an increased MINS incidence and postoperative mortality in diabetic patients. Close monitoring of intraoperative blood glucose level may be helpful in detection and management of MINS.
Highlights
Hyperglycemia is associated with adverse outcomes in various clinical settings [1,2,3].During surgical procedures, blood glucose level elevates as a normal physiological response to surgical stimuli regardless of diabetes status
We aimed to evaluate whether intraoperative hyperglycemia is associated with the incidence of myocardial injury after non-cardiac surgery (MINS) in diabetic patients and estimated the cutoff value of the intraoperative peak blood glucose level associated with MINS
Our study revealed significantly higher risk of in-hospital mortality and 30-day mortality in the BST ≥180 group (4.2% vs. 2.3%; adjusted odds ratio (OR), 1.45; 95% confidence interval (CI), 1.14–1.83; p < 0.001, and 3.1% vs. 1.8%; adjusted OR, 1.94; 95% CI, 1.48–2.56; p < 0.001, respectively) (Table 3)
Summary
Hyperglycemia is associated with adverse outcomes in various clinical settings [1,2,3].During surgical procedures, blood glucose level elevates as a normal physiological response to surgical stimuli regardless of diabetes status. There is a paucity of data on the association between intraoperative blood glucose level and cardiovascular events during non-cardiac surgical procedures. Myocardial injury after non-cardiac surgery (MINS) is the most common cardiovascular complication in surgical patients, with an incidence of 8–18% and is regarded as an independent predictor of mortality [12,13]. Our results may provide valuable evidence supporting the need for close monitoring of glucose levels during non-cardiac surgery in diabetic patients. We aimed to evaluate the effect of intraoperative blood glucose level on the incidence of myocardial injury after non-cardiac surgery (MINS) in diabetic patients. Conclusion: Intraoperative hyperglycemia was associated with an increased MINS incidence and postoperative mortality in diabetic patients. Close monitoring of intraoperative blood glucose level may be helpful in detection and management of MINS
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