Abstract
BackgroundThe benefit results of postoperative tight glycemic control (TGC) were controversial and there was a lack of well-powered studies that support current guideline recommendations.MethodsThe EMBASE, MEDLINE, and the Cochrane Library databases were searched utilizing the key words “Blood Glucose”, “insulin” and “Postoperative Period” to retrieve all randomized controlled trials evaluating the benefits of postoperative TGC as compared to conventional glycemic control (CGC) in patients undergoing surgery.ResultsFifteen studies involving 5053 patients were identified. As compared to CGC group, there were lower risks of total postoperative infection (9.4% vs. 15.8%; RR 0.586, 95% CI 0.504 to 0.680, p < 0.001) and wound infection (4.6% vs. 7.2%; RR 0.620, 95% CI 0.422 to 0.910, p = 0.015) in TGC group. TGC also showed a lower risk of postoperative short-term mortality (3.8% vs. 5.4%; RR 0.692, 95% CI 0.527 to 0.909, p = 0.008), but sensitivity analyses showed that the result was mainly influenced by one study. The patients in the TGC group experienced a significant higher rate of postoperative hypoglycemia (22.3% vs. 11.0%; RR 3.145, 95% CI 1.928 to 5.131, p < 0.001) and severe hypoglycemia (2.8% vs. 0.7%; RR 3.821, 95% CI 1.796 to 8.127, p < 0.001) as compared to CGC group. TGC showed less length of ICU stay (SMD, − 0.428 days; 95% CI, − 0.833 to − 0.022 days; p = 0.039). However, TGC showed a neutral effect on neurological dysfunction (1.1% vs. 2.4%; RR 0.499, 95% CI 0.219 to 1.137, p = 0.098), acute renal failure (3.3% vs. 5.4%, RR 0.610, 95% CI 0.359 to 1.038, p = 0.068), duration of mechanical ventilation (p = 0.201) and length of hospitalization (p = 0.082).ConclusionsTGC immediately after surgery significantly reduces total postoperative infection rates and short-term mortality. However, it might limit conclusion regarding the efficacy of TGC for short-term mortality in sensitivity analyses. The patients in the TGC group experienced a significant higher rate of postoperative hypoglycemia. This study may suggest that TGC should be administrated under close glucose monitoring in patients undergoing surgery, especially in those with high postoperative infection risk.
Highlights
The benefit results of postoperative tight glycemic control (TGC) were controversial and there was a lack of well-powered studies that support current guideline recommendations
In the current meta-analysis of randomized trials, we found that when compared to conventional glycemic control (CGC), TGC immediately after surgery significantly reduces total postoperative infection rates and short-term mortality
TGC had a neutral effect on the risk of postoperative neurological dysfunction and acute renal failure in patients undergoing surgery
Summary
The benefit results of postoperative tight glycemic control (TGC) were controversial and there was a lack of well-powered studies that support current guideline recommendations. Tight glycemic control (TGC) was found to decrease the mortality and morbidity in critically ill patients [1] and it has been recommended as the standard treatment for the duration of the perioperative intensive care unit (ICU) throughout the world. Perioperative hyperglycemia is reported in approximately 20–40% of patients after general surgery [4] and almost 80% of patients undergoing cardiac surgery [5]. Several studies in cardiac surgery and general surgery have shown a clear association between perioperative hyperglycemia and adverse clinical outcomes including delayed wound healing, surgical site infections, and prolonged hospital stay [4, 6]. [9] including cardiac surgery patients reported a reduction of postoperative complications in TGC group Another study. [9] including cardiac surgery patients reported a reduction of postoperative complications in TGC group
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