The Prevalence of Hyperglycemia and the Impact on Perioperative Outcomes in Gynecologic Surgery

Abstract

Study Objective Our primary objective was to estimate the prevalence of preoperative hyperglycemia. Our secondary objectives were to identify risks for hyperglycemia, evaluate the impact of hyperglycemia on perioperative morbidity and to characterize adherence to national diabetes screening guidelines. Design Retrospective cohort study. Setting Tertiary academic medical center. Patients or Participants Patients (n=913) undergoing major gynecologic surgery on an enhanced recovery pathway from January 2018 through July 2019. Interventions Major gynecologic surgery on an enhanced recovery pathway. Measurements and Main Results The prevalence of hyperglycemia (blood glucose ≤140 g/dL) amongst all patients was 7.3%. After adjusting for key clinical and demographic factors, diabetes (aOR 27.2; 95% CI 14.8-50.2) and malignancy (aOR 2.5; 95% CI 1.3-6.6) were associated with increased odds of hyperglycemia. Hyperglycemia was associated with increased odds of composite perioperative complication (aOR 1.9; 95% CI 1.0-3.7). There was no association between blood glucose level and wound complications. Fifty percent of non-diabetic patients met the United States Preventive Services Task Force criteria for diabetes screening, however only 30% of this group had documented diabetes screening in the three years preceding surgery. Conclusion While the prevalence of hyperglycemia in the gynecologic surgery population is low, preoperative hyperglycemia is associated with increased odds of perioperative complication. Additionally, compliance with diabetes screening for at-risk patients is suboptimal. Identifying and managing hyperglycemia in the preoperative period may mitigate surgical risk. Moreover, the preoperative time period provides an opportunity to ensure current diabetes screening in at-risk patients.