Preoperative insulin resistance, postop complications preliminary findings

Abstract

INTRODUCTION: Insulin resistance is a clinical entity recognized in the non-diabetic surgical patient, and either in presence or not of hyperglycemia, it can be associated with adverse outcomes. The present study was set up to identify whether a preoperative state of insulin resistance in non diabetic patients undergoing major elective surgical procedures would influence postoperative complication rate. METHODS: Local IRB approval was obtained for this study. Two-hundred and five adult non-diabetic consecutive patients scheduled for major elective operation (thoracic, abdominal, pelvic and major lower limb joint) were studied. A blood sample was taken in the preoperative clinic to measure fasting plasma glucose and insulin and assess state of insulin resistance using the Homeostasis Model Assesment (HOMA) score[1]. Homa 2.50 insulin resistant. The number and types of postoperative complications and their therapeutic consequences during the fist 30 postoperative days were recorded and classified using the well validated Clavien classification.[2] RESULTS: Metabolic syndrome was present in 26% of the patients studied, and particularly in joints (48%) and abdominal (30%). There were 47 % in the sensitive group, 28% in the borderline group and 25% in the insulin resistant group. While plasma glucose was similar in the groups (mean 5.2 ±0.8), insulin was higher in the joints (75±45), followed by thoracic (61±40), abdominal (47±29) and pelvic (45±20). Approximately 30% of all patients had postoperative complications. Fourteen out of 51 patients (28%) who were insulin resistant before surgery had complications, compared with 15% in the borderline group and 9% in the sensitive group.