Perioperative Blood Glucose Research Articles

Perioperative glycemic status is linked to postoperative complications in non-intensive care unit patients with type-2 diabetes: a retrospective study.

Background:Perioperative hyperglycemia is a risk factor for postoperative complications in the general population. However, it has not been clarified whether perioperative hyperglycemia increases postoperative complications in patients with type-2 diabetes mellitus (T2D). Therefore, we aimed to analyze the relationship between perioperative glycemic status and postoperative complications in non-intensive care unit (non-ICU) hospitalized patients with T2D.Materials and Methods:Medical records of 1217 patients with T2D who were admitted to the non-ICU in our hospital were analyzed retrospectively. Relationships between clinical characteristics including perioperative glycemic status and postoperative complications were assessed using univariate and multivariate analyses. Perioperative glycemic status was evaluated by calculating the mean, standard deviation (SD), and coefficient of variation (CV) of blood glucose (BG) measurements in preoperative and postoperative periods for three contiguous days before and after surgery, respectively. Postoperative complications were defined as infections, delayed wound healing, postoperative bleeding, and/or thrombosis.Results:Postoperative complications occurred in 139 patients (11.4%). These patients showed a lower BG immediately before surgery (P = 0.04) and a higher mean postoperative BG (P = 0.009) than those without postoperative complications. There were no differences in the other perioperative BG parameters including BG variability and the frequency of hypoglycemia. The multivariate analysis showed that BG immediately before surgery (adjusted odds ratio (95% confidence interval [CI]), 0.91 (0.85–0.98), P = 0.01) and mean postoperative BG (1.11 (1.05–1.18), P < 0.001) were independently associated with postoperative complications.Conclusion:Perioperative glycemic status, that is, a low BG immediately before surgery and a high mean postoperative BG, are associated with the increased incidence of postoperative complications in non-ICU patients with T2D.

Incidence and risk factors for poor perioperative blood glucose management in patients with diabetic foot: a retrospective study.

Diabetic foot (DF) is one of the most serious complications of diabetes mellitus (DM). In some cases of DF, life-saving amputation is necessary. This study set out to investigate the situation of preoperative blood glucose management in patients with DF. A retrospective study was performed in two centers between January 2015 and June 2018. Adult patients who received surgical treatment for DF, including amputation, debridement, and flap or skin graft, were included. Demographic and clinical data of the patients were collected. All patients were followed up for at least 3 years, until June 2021. The study outcomes included postoperative mortality, and the incidences of postoperative renal impairment, surgical infection, complete wound closure within 3 months, and reamputation. Univariable and multivariable logistic regression analyses were performed to determine the risk factors for adverse outcomes and poor blood glucose management. Kaplan-Meier curves were generated to compare survival between patients with different preoperative levels of blood glucose. This study included 268 patients with DF, who were divided into four groups: normal (n=72), hyperglycemia (n=95), hypoglycemia (n=44), and mixed (n=57). Total mortality was much higher in the hyperglycemia, hypoglycemia, and mixed groups than in the normal group (P=0.030, 0.009, and 0.014, respectively). The incidences of surgical infection, complete wound closure within 3 months, and reamputation were significantly higher in the hyperglycemia, hypoglycemia, and mixed groups than in the normal group. Older age and a longer duration of DM were confirmed to be important risk factors for hyperglycemia, hypoglycemia, and mixed hyperglycemia and hypoglycemia. Having higher levels of glycosylated hemoglobin (HbA1c) and creatinine and a lower level of albumin was identified as a risk factor for hyperglycemia, hypoglycemia, or mixed hyperglycemia and hypoglycemia. This study emphasizes the importance of perioperative blood glucose management for patients with DF and provides a basis for blood glucose management of these patients in the future.

EP.FRI.98 Perioperative blood glucose monitoring and handover in Post-Laparotomy Diabetic patients admitted to Intensive Care

Abstract Aim To identify the percentage of diabetic laparotomy patients admitted to ITU who had a pre-operative blood glucose check, and the frequency of post-operative blood glucose checks in the immediate 24 hours post-operatively, with any association with 30 day mortality Method We identified diabetic post-laparotomy patients admitted to a large tertiary hospital ICU, identifying handover between medical and critical care teams and perioperative blood glucose monitoring up to the first 24 hours of ICU admission post-operatively using both physical and electronic notes. Results We identified 79 diabetic laparotomy patients admitted to ICU of which 49.3% (39/79) did not have diabetes recorded as a comorbidity in nursing handover charts. We found that 27.8% of these patients did not have an intra-day pre-operative blood glucose recorded and that frequency of post-operative glucose monitoring in the first 24 hours ranged from 0.5 to 10 hourly. ITU monitoring charts could only be found for 69 of the 79 patients, out of which 40.7% of patients had at least one hyperglycaemic episode while 11.6% of patients had a hypoglycaemic episode. We found no correlation between incidences of hyperglycaemia and hypoglycemia or handover with 30 day mortality (13.9%). Conclusion 72.2 percent of post laparotomy diabetic patients admitted to ICU have a preoperative blood glucose recorded, with considerable variance in blood glucose monitoring frequency 24 hours post-laparotomy from half hourly to 10 hours between blood glucose monitoring but we found no association between hyperglycaemic and hypoglycaemic events in the first 24 hours post-laparotomy with 30 day mortality.

Predictors of outcome in diabetic patients undergoing infrapopliteal endovascular revascularization for chronic limb-threatening ischemia

ObjectiveThe incidence of chronic limb-threatening ischemia in diabetic patients is increasing. The factors influencing outcome after infrapopliteal revascularization in these patients are largely unknown. Therefore, this study aims to identify the impact of perioperative glucose control on the long-term outcomes in this patient cohort, and furthermore to identify other factors independently associated with outcome. MethodsConsecutive diabetic patients undergoing infrapopliteal endovascular revascularization for chronic limb-threatening ischemia were identified. Patients' demographics, procedural details, daily capillary blood glucose, and hemoglobin A1C levels were collected and analyzed against the study end points using Kaplan-Meier and Cox regression analysis. ResultsA total of 437 infrapopliteal target vessels were successfully crossed in 203 patients. Amputation-free survival by Kaplan-Meier (estimate (standard error)%) was 74 (3.3)% and 63 (3.7)%, primary patency was 61 (4.2)% and 50 (4.9)%, assisted primary patency was 69 (5.2)% and 55 (6.1)%, and secondary patency was 71 (3.8)% and 59 (4.1)% at 1 year and 2 years, respectively. Cox regression analysis showed high perioperative capillary blood glucose levels to be an independent predictor of binary restenosis (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.31-1.1.78; P = .015). Postprocedural dual-antiplatelet therapy was found to be an independent predictor of amputation-free survival (HR, 1.69; 95% CI, 1.04-2.75; P = .033), and freedom from major adverse limb events (HR: 1.96; 95% CI, 1.16-3.27; P = .023) and baseline estimated glomerular filtration rate was significantly associated with better amputation-free survival (HR, 0.52; 95% CI, 0.31-0.87; P = .014). ConclusionsPoor perioperative glycemic control is associated with a higher incidence of restenosis after infrapopliteal revascularization in diabetic patients. Dual antiplatelet therapy is associated with better outcomes in this group.

Effect of low-concentration carbohydrate on patient-centered quality of recovery in patients undergoing thyroidectomy: a prospective randomized trial

BackroundAt present, low-concentration carbohydrate is rarely used in minor trauma surgery, and its clinical efficacy is unknown. The aim of the study was to evaluate the effect of preoperative oral low-concentration carbohydrate on patient-centered quality of recovery in patients undergoing thyroidectomy using Quality of Recovery − 15 (QoR-15) questionnaire.MethodsOne hundred twenty patients were randomized to oral intake of 300 ml carbohydrate solution (CH group) or 300 ml pure water (PW group) 2 h before surgery or fasting for 8 h before surgery (F group). The QoR-15 questionnaire was administered to compare the quality of recovery at 1d before surgery (T0), 24 h, 48 h, 72 h after surgery (T1, T2, T3), and perioperative blood glucose was recorded.ResultsCompared to the F group, the QoR-15 scores were statistically higher in the CH and PW group at T1 (P < 0.05), and the enhancement of recovery quality reached the clinical significance at T1 in the CH group compared with the F group. Among the five dimensions of the QoR-15 questionnaire, physical comfort, physiological support and emotional dimension in the CH group were significantly better than the F group (P < 0.05) at T1. Besides, blood glucose of CH group was significantly lower than the PW group and F group at each time point after surgery.ConclusionsLow-concentration carbohydrate could decrease the incidence of postoperative hyperglycemia and improve the patient-centered quality of recovery on patients undergoing open thyroidectomy at the early stage postoperatively.Trial registrationChiCTR1900024731. Date of registration: 25/07/2019.

Effect of Acute Stress Glycemic Control and Long-Term Glycemic Control on the Incidence of Post-Operative Infection in Diabetics Undergoing Cardiac Surgery.

ObjectivePost-operative infection after cardiac surgery causes prolonged hospital stay and increased mortality. In patients with diabetes, peri-operative and pre-operative glycemic control have been associated with increased risk of post-operative infection. Saudi Arabia is the 7th highest country in the world for the prevalence of diabetes. In our surgical population the incidence of diabetes is 77%. We were aware of a high incidence of post-operative infections in our institution. The aim of this work was to assess how peri-operative and pre-operative glycemic control was related to the six-week incidence of post-operative infection.MethodWe retrospectively collected data for 174 adult patients with diabetes undergoing cardiac surgery between January 2017 and June 2019. For group analysis of peri-operative glycemic control, a mean value of ≤10 mmol/l was categorized as optimal control and a mean value of >10 mmol/l as sub-optimal control. The admission glucose value, the maximum glucose value and glycosylated hemoglobin A1c (HbA1c) were separately recorded. Admission HbA1c was used for optimal long-term control group (HbA1c ≤ 7%) and sub-optimal long-term control group (HbA1c > 7%).ResultsOf the 174 patients 60 (34%) developed infection in the six-week post-operative period. No statistically significant difference in infections was seen in the optimal peri-operative control group (n = 24, 14%) compared to sub-optimal peri-operative control group (n = 36, 21%; p = 0.113). However, patients with infection had a significantly higher mean glucose (10.4 mmol/l versus 9.9 mmol/l, p = 0.0316) than no infection.Grouping according to their HbA1c: well controlled group (41, 24.0%) and poor control group (130, 76.0%) showed no difference in infections. However, patients with lower HbA1c had better glycemic control as measured by: initial glucose (r = 0.52, p=<0.001); mean peri-operative glucose (r = 0.45, p=<0.001); maximum recorded glucose (r = 0.41, p=<0.001).ConclusionThe majority of our patients presented with sub-optimal long-term glycemic control which we linked to poor stress glycemic control perioperatively. Patients with post-operative infections had higher mean peri-operative blood glucose. With the high incidence of diabetes in Saudi Arabia we have demonstrated the importance of good pre-operative assessment which allows tighter peri-operative glycemic control to reduce post-operative morbidity.

Chinese clinical practice guidelines for perioperative blood glucose management.

With the increased incidence of diabetes, the number of diabetic patients who require surgical treatment is also increasing. Unfortunately, practices in this area lack standardisation. The purpose of this multidisciplinary, evidence-based guidelines for perioperative blood glucose management is to provide a comprehensive set of recommendations for clinicians treating diabetes with different types of surgery. The intended audience comprises Chinese endocrinologists, surgeons, anaesthetists, clinical pharmacists, nurses and professionals involved in perioperative blood glucose management. The guidelines were formulated as follows. First, a multidisciplinary expert group was established to identify and formulate key research questions on topics of priority according to the Population, Intervention, Comparator and Outcomes (PICO) process. We conducted a meta-analysis of available studies using Review Manager version 5.3, as appropriate. We pooled crude estimates as odds ratios with 95% confidence intervals using a random-effects model, and used the Grading of Recommendations Assessment, Development, and Evaluation methods to assess the quality of the retrieved evidence. Finally, 32 recommendations were gathered that covered 11 fields-management and coordination, endocrinologists' consultation, diabetes diagnosis, surgery timing and anaesthesia method, blood glucose target values and monitoring frequency, hypoglycaemia treatment, oral administration of blood glucose lowering drugs, use of insulin, enteral and parenteral nutritional, postoperative treatment and medication and education and training. Twenty-five systematic reviews and meta-analyses were conducted for these guidelines to address the PICO questions. These guidelines are intended to improve perioperative blood glucose management and help doctors in specifying medical diagnosis and treatment, and will be implemented / disseminated extensively in China.

Effects of propofol, desflurane and isoflurane on perioperative blood glucose level in intracranial mass operation: A randomized controlled trial

The aim of this study is to compare the effects of the propofol, desflurane and isoflurane on blood glu-cose levels in cranial surgery. Ninety, ASA I-II patients aged between 18-60 years old were scheduled for study. Induction was per-formed with fentanyl, propofol and cisatracurium in all patients. Anaesthesia was maintained using propofol 4-6 mg/kg/h in propofol group (Group P), desflurane and isoflurane 0.5-1 MAC in group desflurane (Group D) and group isoflurane (Group I). Remifentanil infusion was applied 0.5 µg/kg/min in all groups. Plasma glucose (PG) levels, systolic arterial pressure (SAP), diastolic arterial pressure, mean arterial pressure and heart rate measured. In the 1st, 2nd and 5th hour, PG levels were significantly lower in group P than group D. In the 2nd and 3rd hour, PG levels were significantly lower in group P than group I (p &lt;0.05). In addition, SAP values in group D were found to be significantly lower than group P and group I. With this study, it was concluded that total intravenous anesthesia with propofol infusion in intracranial mass surgery is more effective than inhalation anesthesia such as desflurane and isoflurane in preventing the hyperglycemic response caused by surgical stress.

Mediastinitis after cardiac surgery: risk factors and our vacuum-assisted closure results.

IntroductionMediastinitis after cardiac surgery is a rare complication, but with high morbidity and mortality.AimTo determine its risk factors and to investigate the efficacy of vacuum-assisted closure (VAC).Material and methodsNine thousand one hundred sixty cases of patients who underwent cardiac surgery during 2010–2017 were reviewed retrospectively. One hundred and twenty-seven patients, the case group, were treated by VAC. Three hundred cases with no diagnosis of mediastinitis were selected as the control group. Both groups’ clinical and demographic characteristics, preoperative variables, and postoperative follow-up parameters were compared. Factors affecting treatment were analyzed.ResultsWe found that the presence of diabetes mellitus, bilateral internal thoracic artery and intra-aortic balloon pump usage are independent risk factors for the development of mediastinitis (p < 0.05). It was found that 74% of tissue cultures were positive and the most common detected organism was Staphylococcus. It was found that many perioperative parameters had a significant effect on the duration of treatment (p < 0.05). However, regression analysis revealed that bacterial growth was the only independent variable in prolonging the treatment period.ConclusionsWe believe that the establishment of perioperative blood glucose regulation, patient selection to use bilateral internal thoracic artery grafts, and maximum attention to sepsis and antisepsis rules in patients who need mechanical support devices such as intra-aortic balloon pump, will significantly reduce the development of mediastinitis. Since we could not find an independent risk factor for the duration of VAC treatment other than culture growth, we think that VAC therapy is successful and safe in the treatment of mediastinitis and should be used more widely.

Impact of Perioperative Blood Glucose on Surgical Outcomes after Pancreatic Resections

Impact of Perioperative Blood Glucose on Surgical Outcomes after Pancreatic Resections

Perioperative ADministration of Dexamethasone And blood Glucose concentrations in patients undergoing elective non-cardiac surgery - the randomised controlled PADDAG trial.

The hyperglycaemic effect of dexamethasone in diabetic and nondiabetic patients in the peri-operative period is unknown. To assess the effect of a single dose of intra-operative dexamethasone on peri-operative blood glucose. Multicentre, stratified, randomised trial. University hospitals in Australia and Hong Kong. A total of 302 adults scheduled for elective, noncardiac and nonobstetric surgical procedures under general anaesthesia, stratified by diabetes mellitus status, were randomised to receive placebo, 4 or 8 mg dexamethasone administered intravenously after induction of anaesthesia. Maximum blood glucose within 24 h of surgery, and the interaction between glycated haemoglobin (HbA1c) and dexamethasone were the primary and secondary outcomes. The median [IQR] baseline blood glucose in the nondiabetes stratum in the placebo (n=81), 4 mg (n=81) and 8 mg dexamethasone (n=77) trial arms were respectively 5.3 [4.6 to 5.8], 5.0 [4.7 to 5.4] and 5.0 [4.2 to 5.9] mmol l-1. In the diabetes stratum these values were 6.6 [6.0 to 8.3]; (n=22), 6.1 [5.5 to 10.4]; (n=22) and 6.7 [5.6 to 8.3]; (n=19) mmol l-1. The median [IQR] maximum peri-operative blood glucose values in the nondiabetes stratum were 6.0 [5.3 to 6.8], 6.3 [5.5 to 7.3] and 6.3 [5.8 to 7.4] mmol l-1 in the control, dexamethasone 4 mg and dexamethasone 8 mg arms, respectively. In the diabetes stratum these values were 10.3 [8.1 to 12.4], 12.6 [10.3 to 18.3] and 13.6 [11.2 to 20.1] mmol l-1. There was a significant interaction between pre-operative HbA1c value and 8 mg dexamethasone: every 1% increment in HbA1c produced a 4.0 mmol l-1 elevation in maximal peri-operative glucose concentration. Dexamethasone 4 mg or 8 mg did not induce greater hyperglycaemia compared with placebo for nondiabetic and well controlled diabetic patients. Maximal peri-operative blood glucose concentrations in patients with diabetes were related to baseline HbA1c values in a concentration-dependent fashion after 8 mg of dexamethasone. Australia and New Zealand Clinical Trials Registry (ACTRN12614001145695): URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367272.

Variations of Perioperative Cardiac Surgery Blood Glucose and Glycemic Variability in Diabetes and Non-Diabetes

Background: Not only perioperative high blood glucose but also glycemic variability (GV) is significantly associated with mortality in cardiac surgery. Perioperative hyperglycemia in diabetes (DM) patients is well-known, however, there is less information in non-diabetes (non-DM) patients. Objective: The present study objectives were to show the variations of perioperative blood glucose, to compare the characteristics, frequency, and severity of hyperglycemia, and to compare GV between non-DM and DM undergoing cardiac surgery. Materials and Methods: A prospective observational study was conducted between January 2016 and July 2018. Cardiac-surgery patients, age 20 to 80 years, undergoing cardiopulmonary bypass (CPB) were recruited. The differentiation between the DM and the non-DM was based on standard diagnosis. Perioperative blood glucose was measured every 30 minutes by POCT-glucose and controlled by insulin based on the institutional protocol. GV measures were standard deviation (SD), coefficient of variance (CV), and mean absolute glucose (MAG). Characteristics of blood glucose changes were demonstrated, which were related to events or surgical procedure. Comparison of blood glucose, GV, and events of hyperglycemia were carried out using Student t-test or chi-square test as appropriate. Results: Perioperative hyperglycemia were 60% in DM and 30% in non-DM. Hyperglycemia started at the beginning of the operation in DM and in late CPB in non-DM. Inotropes or vasopressors was associated with sharp shooting increases of blood glucose. Hyperglycemia with more severity was commonly found during the early postoperative period in both DM and non-DM. The GV of DM was higher than in non-DM. The average MAG were 31.98 and 28.05 mg/dl/hour in DM and non-DM, which was the only measure that could significantly differentiate DM and non-DM. Conclusion: Perioperative hyperglycemia in cardiac surgery occurred in both non-DM and DM despite the treatment by insulin infusion. Inotropes or vasopressors infusion was significantly related to a sudden hyperglycemia. MAG might be a better monitor of GV than SD and CV during cardiac surgery. Trial registration: Thai Clinical Trials Registry, TCTR 20190411005 Keywords: Hyperglycemia, Glycemic variability, Mean absolute glucose, Cardiac surgery

Impact of using a perioperative artificial endocrine pancreas in pancreatic resection.

AimPancreatectomy causes both hyperglycemia, secondary to surgical stress, and pancreatic diabetes, which leads to difficult‐to‐control postoperative blood glucose levels. We investigated whether using an artificial pancreas perioperatively to provide appropriate blood glucose control could reduce postoperative complications following pancreatectomy.MethodsWe retrospectively enrolled 52 patients who underwent pancreatectomy at Tokushima University Hospital from 2015 to 2019. The most recent 26/52 patients received perioperative blood glucose control using an artificial pancreas. Postoperative blood glucose control with manual insulin injections based on a sliding scale was performed in the earlier 26 patients (controls). We compared surgical outcomes between the artificial pancreas group and the control group.ResultsThere was no significant difference in patients' white blood cell or neutrophil counts, prognostic nutritional index, neutrophil‐lymphocyte ratio, and C‐reactive protein‐to‐albumin ratio on postoperative day 1; however, lymphocyte counts were higher in the artificial pancreas group. The number of serious complications of Clavien‐Dindo grade >IIIa was significantly lower in the artificial pancreas group (P < .05).ConclusionsUsing an artificial pancreas for perioperative blood glucose control in patients undergoing pancreatectomy decreased the number of serious complications through proper management of blood glucose levels without hypoglycemia, and may influence peripheral lymphocytes.

2200-PUB: Application of Data Envelopment Analysis in Health Economic Evaluation of Insulin Pump Treatment during Perioperative Period

Objective: To evaluate the effect of insulin pump on perioperative patients with type 2 diabetes and the role of health economics by applying data envelopment analysis (DEA). Method: This retrospective study involved 639 patients with type 2 diabetes undergoing surgery in Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2009 to November 2017. All patients were treated with insulin during the perioperative period. They were divided into a insulin pump group for diabetes (perioperative blood glucose control with insulin pump, 369 cases) and a Non-insulin pump group (perioperative blood glucose control with subcutaneous insulin injection, 270 cases). Data Envelope analysis was applied to compare the input indicators of the two groups to total cost and total length of hospital stay. The output indicators of the two groups were blood glucose control time before surgery, mean fasting blood glucose, blood glucose in the first sky after surgery, days of antibiotic use, and hospital stay after surgery. Result: In the aspect of comparison of scale efficiency, the efficiency values of the pump set in the C2R model and BC2 model are better than those of the unused pump set. In Another aspect of the relaxation variables, the higher the surgical level, the closer the pump group is to the ideal state compared with the non-pump group, in terms of improving average fasting blood glucose, antibiotic use days, preoperative blood glucose control time, first day postoperative fasting blood glucose, and postoperative hospitalization days. Conclusion: Insulin pump can quickly and stably control blood glucose levels and shorten the length of hospital stay during the perioperative period of type 2 diabetes patients. It is suggested that the application of insulin pump in perioperative period may have better benefits and is worthy of clinical promotion. Disclosure W. Song: None. J. Wen: None. L. Zhao: None. G. Fan: None. M. Luo: None. J. Liang: None. J. Zhang: None. C. Yang: None. Q. Wang: None. Z. Gao: None. L. Ma: None.

Characterizing Perioperative Blood Glucose on an Enhanced Recovery After Surgery Pathway for Cesarean Delivery [06P

INTRODUCTION: Enhanced recovery after surgery (ERAS) pathways are standardized, evidence-based approaches to the care of surgical patients. One component of ERAS pathways is maintaining euglycemia pre- and post-operatively. METHODS: We conducted an IRB approved retrospective cohort study evaluating capillary blood glucose (CBG) values among women on the ERAS cesarean delivery pathway (ERAS CD) during the first year of implementation (4/1/2017–3/31/2018, n=531). Pregestational diabetics on insulin prior to pregnancy were excluded. ERAS CD pathway patients received a pre-op, 1-hour post-op, and post-op day 1 and 2 CBG. We calculated average CBG and percentage of time in-range, defined as any CBG between 70–140 mg/dL for all patients on the ERAS CD pathway, and stratified for type 2 diabetics (T2DM), gestational diabetics (GDM), and non-diabetics. RESULTS: Most patients had CBGs in-range preoperatively (n=268, 95.4%): 89.6% for T2DM, 89.8% for GDM, and 97.1% for non-diabetics. The average pre-op CBG was 87.5±15.7 mg/dL overall, 96.2±30.4 mg/dL for T2DM, 90.4±17.0 mg/dL for GDM, and 86.4±14.8 mg/dL for non-diabetics. Post-operatively, 94.3% (n=502) of patients had CBGs in-range: 66.8% for T2DM, 87.1% for GDM, and 95.5% for non-diabetics. The average post-op CBG was 90.9±17.8 mg/dL overall, 99.2±26.6 mg/dL for T2DM, 94.9±20.6 mg/dL for GDM, and 90.2±17.2 mg/dL for non-diabetics. CONCLUSION: Preoperatively most patients had in-range CBGs. Postoperatively, CBGs for non-diabetics and GDM remained primarily in-range, while CBGs for T2DM were more variable. For non-diabetic women it may not be useful to check pre- or post-operative CBGs as most will be within range. Further studies are needed to evaluate this aspect of care.

Perioperative glycemic control in patients with coronary artery disease and diabetes mellitus type 2 undergoing coronary artery bypass grafting: results of pilot study

BACKGROUND: According to different studies, diabetes mellitus type 2 (DM2) is associated with higher mortality after undergoing coronary artery bypass grafting (CABG). Perioperative hyperglycaemia, even in non-DM2 patients, is associated with adverse outcomes after CABG. Thus, successful perioperative blood glucose control (BGC) is mandatory to reduce the risk of death and postoperative complications. Nowadays, the most effective method for BGC in the operating room is still unknown.&#x0D; AIMS: To assess the continuous glucose monitoring (CGM) efficacy in association with insulin pump therapy in patients with coronary artery disease (CAD) and DM2 undergoing CABG in intra- and early postoperative periods.&#x0D; METHODS: The study involved 97 patients undergoing isolated CABG. Patients were divided into two groups: 48 patients with DM2 and 49 patients without DM2. In both groups of patients, we used CGM in intra- and early postoperative periods (72 hours). In some patients with DM2, CGM was associated with insulin pump therapy (MiniMed Paradigm Veo 554/754) to successfully control postoperative glucose level. Besides commonly used tests (such as HbA1C and lipid profile), we analysed high sensitive C-reactive protein (hs-CRP) levels before surgery, and then at 1 hour, 12 hours and 7 days after CABG in order to estimate their prognostic value.&#x0D; RESULTS: During the 48 hours after CABG, there was a trend towards having higher glucose levels in both groups of patients with and without DM2 according to CGM. In patients with DM2, the glucose level was significantly increased (р0,05). Insulin pump therapy resulted in glycemic control improvement in early follow-up (72 hours). Moreover, there were no hypoglycaemic episodes in patients on insulin pump therapy and also in patients prescribed bolus insulin therapy. We revealed the trend towards lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p=0,1). Hs-CRP level was lower in patients with DM2 who were on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р0,05). This most likely confirms that insulin pump therapy decreases systemic inflammatory response.&#x0D; CONCLUSIONS: Thus, we demonstrated the CGM feasibility, safety and efficacy in association with insulin pump therapy in patients with DM2 undergoing CABG.

Application of Multi-team Blood Glucose Management Model in Perioperative Period of General Surgery Patients

Objective. In order to explore the application effect of blood glucose management mode of multi-team cooperation in perioperative period of general surgery patients. Methods. The perioperative blood glucose control of 94 patients undergoing surgical treatment in general surgery from January 2016 to March 2019 was reviewed by Non-synchronous. According to the perioperative blood glucose management model of multi-team cooperation, the patients were divided into intervention group and control group. From January 2016 to January 2018, 64 patients who did not implemented the multi-team blood glucose management model were the control group and from February 2018 to March 2019, 30 patients who implemented the multi-team blood glucose management model were the intervention group, compared with two group about the differences in perioperative blood glucose. Results. It is no statistically significant about two group in highest and lowest blood sugar levels under fasting stats; during the fluid diet the blood sugar level of the intervention group was lower than control group(P&lt;0.05),and when the patients was in the semi-fluid or food-feeding period, the highest and lowest blood sugar level is that the intervention group was lower than control group(P&lt;0.05). The time of the blood sugar reaching the standard, the coincidence of complications rate and average hospitalization days in the intervention group were particularly lower than control group(P&lt;0.05). Conclusion. If we adopt multi-team blood glucose management model can better control the perioperative blood glucose of patients undergoing general sugar.

Modified Glucose-Insulin-Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion in Patients Undergoing Cardiopulmonary Bypass Surgery.

BackgroundLaboratory studies demonstrate glucose‐insulin‐potassium (GIK) as a potent cardioprotective intervention, but clinical trials have yielded mixed results, likely because of varying formulas and timing of GIK treatment and different clinical settings. This study sought to evaluate the effects of modified GIK regimen given perioperatively with an insulin‐glucose ratio of 1:3 in patients undergoing cardiopulmonary bypass surgery.Methods and ResultsIn this prospective, randomized, double‐blinded trial with 930 patients referred for cardiac surgery with cardiopulmonary bypass, GIK (200 g/L glucose, 66.7 U/L insulin, and 80 mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg per hour 10 minutes before anesthesia and continuously for 12.5 hours. The primary outcome was the incidence of in‐hospital major adverse cardiac events including all‐cause death, low cardiac output syndrome, acute myocardial infarction, cardiac arrest with successful resuscitation, congestive heart failure, and arrhythmia. GIK therapy reduced the incidence of major adverse cardiac events and enhanced cardiac function recovery without increasing perioperative blood glucose compared with the control group. Mechanistically, this treatment resulted in increased glucose uptake and less lactate excretion calculated by the differences between arterial and coronary sinus, and increased phosphorylation of insulin receptor substrate‐1 and protein kinase B in the hearts of GIK‐treated patients. Systemic blood lactate was also reduced in GIK‐treated patients during cardiopulmonary bypass surgery.ConclusionsA modified GIK regimen administered perioperatively reduces the incidence of in‐hospital major adverse cardiac events in patients undergoing cardiopulmonary bypass surgery. These benefits are likely a result of enhanced systemic tissue perfusion and improved myocardial metabolism via activation of insulin signaling by GIK.Clinical Trial RegistrationURL: clinicaltrials.gov. Identifier: NCT01516138.

11 Tube Feeding Through Surgery, Impact on Glucose Control in Burn Patients

Abstract Introduction The hypermetabolic state experienced by burn patients post injury puts nutritional support at the forefront of these patients’ care. Enhanced Recovery After Surgery (ERAS) algorithms include a radical approach of feeding patients up to surgery with reported advantages like earlier recovery of GI function, among others. The purpose of this study was to assess perioperative blood glucose (BG) levels in patients fed up to and through surgery at our institution. Methods Charts of selected surgical burn patients were reviewed and categorized on the basis of diabetic status and whether they had procedures in which feeds were continued to within four hours of surgery (“fed”) and stopped at least four hours prior to surgery (“unfed”). Percent change in pre- and post-op BG levels were compared between groups. Wilcoxon Rank-Sum and Two-Sample testing were used for statistical analyses. Results See Table 1. Data collection yielded 32 patients with 106 unfed and 92 fed procedures. There was a significantly larger percent change in BG levels from 24-hr pre-op to 12- and 24-hr post-op in the unfed vs. fed groups across all procedures, prior to grouping based on diabetic status (p = 0.014 and p = 0.009, respectively). There was a statistically significant difference in the percent change in BG levels from 24-hr pre-op to 12- and 24-hr post-op in the pre-diabetes group (p = 0.021 and p = 0.026, respectively). Conclusions Our data shows better BG control in fed procedures with lower percent change from pre-op to post-op overall, and in the pre-diabetes group. These findings are in line with ERAS literature. Controlling BG ranges post-op is critical to prevent complications and promote healing. Improved BG control using perioperative nutrition could guide practices related to perioperative workup of burn patients. This is worth further investigation since better BG management has been associated with superior patient outcomes. Applicability of Research to Practice 1) Using enteral nutrition up to and/or through surgery contributes to better glycemic control postoperatively in surgical burn patients. 2) The most pronounced benefits of perioperative enteral nutrition in terms of glycemic control are seen in burn patients with pre-diabetes.

Risk factor analysis for perineal incision complications after abdominoperineal resection in elderly patients with rectal cancer

Objective: To evaluate the risk factors of perineal incision complications after abdominal abdominoperineal resection (APR) in elderly patients with rectal cancer. Methods: From January 2007 to September 2018, the clinical data of 72 elderly rectal cancer patients (age≥80 years) underwent abdominoperineal resection at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were collected and retrospectively analyzed. Univariate and multivariate analyses were performed to determine the risk factors of perineal incision complications in elderly patients with rectal cancer after APR. Results: Of the 76 patients, 47 were male and 25 were female, with an average age of (81.8±1.8) years. The incidence of postoperative perineal incision complications was 23.6% (17/72), including 5 cases of wound infection, 4 cases of incision fat liquefaction, and 8 cases of delayed wound healing. All of the patients were well recovered and discharged without death. The result of univariate analysis showed that, the occurrence of perineal incision complications was associated with serum albumin level < 35g/L (χ(2)=4.860, P=0.027), intraperitoneal chemotherapy with fluorouracil sustained release/lobaplatin rinse (χ(2)=8.827, P=0.003), pelvic restoration (χ(2)=9.062, P=0.003), diabetes (χ(2)=6.387, P=0.011) and coronary heart disease (χ(2)=7.688, P=0.006). Multivariable logistic regression analysis showed that the intraoperative pelvic restoration (OR=0.17, 95% CI: 0.04~0.82, P=0.027) and diabetes (OR=4.32, 95% CI: 1.05~17.81, P=0.043) were independent risk factors for perineal incision complications. Conclusions: Elderly patients with rectal cancer who undergo APR should preserve and restore the pelvic peritoneum as much as possible. Moreover, perioperative blood glucose monitoring is a powerful guarantee for preventing complications of perineal incision.