Postoperative Hyperglycemia Research Articles

Exhortation to lose weight prior to complex ventral hernia repair: Nudge or noodge?

BackgroundExercise and weight loss are recommended for patients with obesity undergoing elective complex ventral hernia repair (cVHR). MethodsWeight and BMI trajectory data on 230 obese patients undergoing cVHR from 2012 to 2017 were retrospectively analyzed from 12 months prior to first visit with the hernia surgeon to 12 months after surgery. ResultsOne year prior to initial visit, 76 (33%) patients had lost > 1kg/m2, 98 (43%) had gained> 1kg/m2, and 56 (24%) had no change in body mass index (BMI). Between initial visit and operation, 53 (23%) lost >1kg/m2, 43 (19%) gained, and 134 (58%) had no change. Post-operative hyperglycemia was associated with BMI> 40kg/m2 at time of operation. Twelve months post-operatively, 69 (35%) had lost >1kg/m2, while 52 (26%) had gained, and 108 (47%) had no change. ConclusionsExhortations for pre-operative and post-operative weight management are not often successful or sustainable, implying a need for individualized holistic approaches.

The Role of Genetic Variant rs13266634 in SLC30A8/ZnT8 in Postoperative Hyperglycemia After Major Abdominal Surgery.

Following major surgery, postoperative hyperglycemia (POHG) is associated with suboptimal outcomes among patients with diabetes and nondiabetic patients. A specific genetic variant, rs13266634 (c.973C>T; p.ARG325TRP) in zinc transporter SLC30A8/ZnT8, is associated with protection against type 2 diabetes (T2D), suggesting it may be actionable for predicting and preventing POHG. To determine independent and mediated influences of a genetic variant on POHG in patients undergoing a model major operation, complex ventral hernia repair (cVHR). For 110 patients (mean body mass index, 34.9 ± 5.8; T2D history, 28%) undergoing cVHR at a tertiary referral center (January 2012 to March 2017), multivariable regression was used to correlate the rs13266634 variant to preoperative clinical, laboratory, and imaging-based indices of liver steatosis and central abdominal adiposity to POHG. Causal mediation analysis (CMA) was used to determine direct and mediated contributions of SLC30A8/ZnT8 status to POHG. Variant rs13266634 was present in 61 patients (55.4%). In univariate models, when compared with patients with homozygous wild-type genotype (C/C, n = 49), rs13266634 was associated with significantly lower risks of POHG (OR, 0.30; 95% CI, 0.14 to 0.67; P = 0.0038). Multivariable regression indicated that the association was independent (OR, 0.39; 95% CI, 0.15 to 0.97; P = 0.040). Additionally, CMA suggested that rs13266634 protects against POHG directly and indirectly through its influence on liver steatosis and central adiposity. In medically complex patients undergoing major operations, the rs13266634 variant protects against POHG and its associated outcomes, through independent and mediated contributions. In C/C patients undergoing major operations, SLC30A8/ZnT8 may prove useful to stratify the risk of POHG and potentially as a therapeutic target.

Ethnicity and postoperative hyperglycaemia in a South-East Asian population undergoing cardiac surgery

Postoperative hyperglycaemia is a known risk factor of adverse outcomes following cardiac surgery.[1][1] Although South Asian ethnicity is a known risk factor of postoperative hyperglycaemia,[2][2] variances in risk profile between the different ethnicities of the Singaporean multi-ethnic South-East

Postoperative hyperglycemia in patients undergoing cytoreductive surgery and HIPEC: A cohort study

BackgroundHyperglycemia following elective or emergency surgery is generally associated with an increased risk of complications. The impact of hyperglycemia following surgery for peritoneal surface malignancy remains unclear. Materials and methodsRecords of patients undergoing cytoreduction and HIPEC for peritoneal surface malignancy were reviewed at two institutions. Postoperative hyperglycemia was defined as serum glucose >140 mg/dl at the first measurement after surgery. Lengths of stay and 30-day complication rates were recorded. ResultsThere were 115 total patients included, 65 from Institution A (A) and 50 from Institution B (B). Perioperative steroids were given to 55% (A) and 100% (B) of patients, with postoperative hyperglycemia present in 39% and 86% of patients respectively. Complication rates were not significantly different in patients with hyperglycemia versus patients who were normoglycemic at each site [56% vs. 53%, p = 0.8 at (A); 47% vs. 43%, p = 1.0 at (B)]. Infection rates were also similar between groups [16% vs. 13%, p = 0.72 at (A); 14% vs. 29%, p = 0.31 at (B)]. ConclusionsRates of hyperglycemia in patients undergoing cytoreduction and HIPEC are high. This likely represents a stress response but does not seem to have the same adverse impact as seen in other abdominal surgical patient populations.

The Disparate Effects of Epinephrine and Norepinephrine on Hyperglycemia in Cardiovascular Surgery.

Hyperglycemia is a metabolic derangement that frequently develops after cardiovascular surgery. The perioperative administration of inotropic and vasoactive agents, such as epinephrine and norepinephrine, are common in the management of cardiac surgery patients and are known to contribute to the development of postoperative hyperglycemia. We hypothesized that hemodynamic support with epinephrine exacerbates postoperative hyperglycemia to a greater degree than does treatment with norepinephrine. This literature review outlines the mechanisms by which epinephrine and norepinephrine alter glucose homeostasis, while highlighting the significant differences in their effects on hepatic glucose mobilization and peripheral glucose utilization. This review suggests that the use of epinephrine exacerbates postoperative hyperglycemia to a greater degree than does norepinephrine.

Dexamethasone and postoperative hyperglycemia in diabetics undergoing elective hip or knee arthroplasty: a case control study in 238 patients

BackgroundDexamethasone has been routinely used in the pre-operative setting to enhance analgesia and decrease the incidence of nausea and vomiting in patients undergoing primary arthroplasty. However, dexamethasone has the potential to increase blood glucose levels postoperatively, which is a known risk factor for complications after total joint arthroplasty. The aim of this study was to analyze the effect of dexamethasone administration on post-operative blood glucose levels in diabetic patients after primary hip and knee arthroplasty.MethodsThis study was a retrospective review of 238 diabetic patients who underwent primary hip and knee arthroplasty between May 1, 2014 and September 30, 2016 at a single urban academic medical center. A total of 77 patients (32.4%) received dexamethasone and 161 (67.7%) did not. Oral hyperglycemic agents were held during the inpatient stay and blood glucose was controlled either with sliding scale insulin or home insulin regimens were continued. All analyses were adjusted for age, BMI, gender, type of diabetes, pre-operative diabetic medication, type of surgical procedure, and pre-operative HgbA1c level. The primary outcome was post-operative hyperglycemia within 72 h of surgery defined as any blood glucose level greater than or equal to 200 mg/dL.ResultsPost-operative hyperglycemia was observed in 17.1 and 20.6% of the measurements during the first 24 and 72 h respectively. After controlling for confounding variables, patients who received dexamethasone had 4.07 (95% CI: 2.46, 6.72) and 3.08 (95% CI: 2.34, 4.04) higher odds of post-operative hyperglycemia in the first 24 and 72 h respectively.ConclusionsDexamethasone administration in diabetic patients undergoing primary arthroplasty increases post-operative hyperglycemia during the first 24 and 72 h. While our data did not investigate causation, dexamethasone use in this patient population should be thoughtfully considered, as post-operative hyperglycemia is a known risk factor for complications.

Blood Glucose Management for Reducing Cardiac Surgery Infections.

Stress-induced hyperglycemia can occur after cardiac surgery unless the patient is carefully managed. Postoperative hyperglycemia is typically associated with surgical site infections and mediastinitis, resulting in a longer length of stay and escalated costs for the hospitalization. The American Association of Clinical Endocrinologists recommend keeping the intraoperative and postoperative blood glucose levels below 180 mg/dL to avoid postoperative infections. This article describes the effectiveness of a Glucose Management Team tasked with ensuring that blood glucose levels are maintained within these recommended guidelines, starting with day of admission and extending through the first postoperative day. Team members review blood glucose levels and provide clinical data relevant to regulating insulin infusions and nutritional intake, major factors in influencing positive patient outcomes. This article reports the successes of the Glucose Management Team in reducing cardiac surgery infections. The successes of the endeavor led other hospital surgical divisions to adopt the protocol for their patients.

Identifying Patients at Risk for Postoperative Hyperglycemia after Elective Colorectal Surgery

Identifying Patients at Risk for Postoperative Hyperglycemia after Elective Colorectal Surgery

Impact of Postoperative Hyperglycemia on Postoperative Morbidity and Overall Survival in Patients Undergoing Oncologic Pancreatic Surgery

Impact of Postoperative Hyperglycemia on Postoperative Morbidity and Overall Survival in Patients Undergoing Oncologic Pancreatic Surgery

Development of a Predictive Model for Hyperglycemia in Nondiabetic Recipients After Liver Transplantation.

BackgroundPosttransplant hyperglycemia has been associated with increased risks of transplant rejection, infections, length of stay, and mortality.MethodsTo establish a predictive model to identify nondiabetic recipients at risk for developing postliver transplant (LT) hyperglycemia, we performed this secondary, retrospective data analysis of a single-center, prospective, randomized, controlled trial of glycemic control among 107 adult LT recipients in the inpatient period. Hyperglycemia was defined as a posttransplant glucose level greater than 200 mg/dL after initial discharge up to 1 month following surgery. Candidate variables with P less than 0.10 in univariate analyses were used to build a multivariable logistic regression model using forward stepwise selection. The final model chosen was based on statistical significance and additive contribution to the model based on the Bayesian Information Criteria.ResultsForty-three (40.2%) patients had at least 1 episode of hyperglycemia after transplant after the resolution of the initial postoperative hyperglycemia. Variables selected for inclusion in the model (using model optimization strategies) included length of hospital stay (odds ratio [OR], 0.83; P < 0.001), use of glucose-lowering medications at discharge (OR, 3.76; P = 0.03), donor female sex (OR, 3.18; P = 0.02) and donor white race (OR, 3.62; P = 0.01). The model had good calibration (Hosmer-Lemeshow goodness-of-fit test statistic = 9.74, P = 0.28) and discrimination (C-statistic = 0.78; 95% confidence interval, 0.65-0.81, bias-corrected C-statistic = 0.78).ConclusionsShorter hospital stay, use of glucose-lowering medications at discharge, donor female sex and donor white race are important determinants in predicting hyperglycemia in nondiabetic recipients after hospital discharge up to 1 month after liver transplantation.

Effects of Glucose Variability on Short-Term Outcomes in Non-Diabetic Patients After Coronary Artery Bypass Grafting: A Retrospective Observational Study

Postoperative hyperglycaemia has been shown to have adverse effects on patients after coronary artery bypass grafting surgery (CABG). However, whether glucose variability has an effect on patients' outcomes is still uncertain. The aim of this study is to explore the effects of glucose variability on short-term outcomes in non-diabetic patients undergoing coronary artery bypass grafting. This is a retrospective observational study utilising data collected after patients had left the hospital. This study was performed on 137 non-diabetic patients undergoing coronary artery bypass grafting from January 2011 to June 2013. Blood glucose at 72hours post operation was obtained and glucose variability was measured by mean postoperative blood glucose and mean of daily difference (MODD). Short-term outcomes included duration of intensive care unit (ICU) stay, mechanical ventilation time, length of hospital stay, and occurrence of arrhythmia. Patients with mean postoperative blood glucose ≥7.00mmol/L were defined as hyperglycaemic, and patients with MODD ≥1.40mmol/L were considered to be abnormal. Outcome variables were compared between patients in euglycaemic and hyperglycaemic groups, and between patients in normal and abnormal groups. In our study, patients with hyperglycaemia spent more time staying in ICU (p<0.01), and patients with large glucose variability (abnormal MODD) had higher incidences of arrhythmia (23% vs 4.2%, p<0.05). Regression analysis showed that MODD can affect occurrence of arrhythmia (p=0.004) and that mean postoperative blood glucose levels can affect duration of ICU stay (p<0.001). Patients' postoperative glucose variability after CABG is an important predictor of the negative outcomes regarding duration of ICU stay and occurrence of arrhythmia. Large glucose variability can have negative effects on short-term outcomes in patients.

Machine learning and predictive analytics aid in individualizing risk profiles for patients undergoing minimally invasive left pancreatectomy

Introduction: An increasing proportion of left pancreatectomies (LP) are being performed in a minimally invasive fashion; however, patients undergoing minimally invasive LP remain at risk for significant postoperative morbidity. Machine learning and predictive analytics may be able to provide surgeons with more accurate risk profiles on individual patients. Methods: 273 patients who underwent minimally invasive LP from January 2008 through June of 2017 at our institution were included in the study. We used that population to construct our predictive model. Bivariate analysis was used to exclude those independent variables not attaining a significance of p < 0.25, followed by multivariate analysis, which excluded those not significant at p < 0.05. Receiver operating characteristic (ROC) value and Brier scores were used to assess the predictive ability of the model. Internal validation was assessed with bootstrap logistic regression. The outcomes chosen for analysis were 90 day mortality, length of stay, pancreatic leak rate, and postoperative hyperglycemia. Results: ROC values for predicting 90 day mortality, type B/C pancreatic leak rate, and postoperative hyperglycemia were 0.93 (p = 0.0001), 0.74 (p = 0.0002), and 0.85 (p = 0.001), respectively. The model also demonstrated a strong correlation between our independent variables and length of stay (r2 = 0.53). Conclusion: The data show that this novel predictive model can be used to anticipate important postoperative outcomes with a high degree of accuracy. This may aide in both perioperative decision making, discussing expected outcomes with patients, and in allocation of resources.

Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair

ObjectiveWe evaluated the association between postoperative hyperglycemia and outcomes after abdominal aortic aneurysm (AAA) repair. MethodsWe used diagnosis and procedure codes (International Classification of Diseases, Ninth Revision, Clinical Modification) to identify patients who underwent open or endovascular repair of a nonruptured AAA from September 2008 to March 2014 from the Cerner Health Facts database (Cerner Corporation, North Kansas City, Mo). We evaluated the association between postoperative hyperglycemia (glucose concentration >180 mg/dL) and infections, in-hospital mortality, readmission, patients' characteristics, length of hospital stay, and medications. Multivariable logistic models examined the association of postoperative hyperglycemia with in-hospital infection and mortality. ResultsOf 2478 patients, 2071 (83.5%) had good postoperative glucose control (80-180 mg/dL), and 407 (16.5%) had suboptimal control (hyperglycemia). Patients who had postoperative hyperglycemia experienced longer hospital stays (9.5 vs 4.7 days; P < .0001), higher infection rates (18% vs 8%; P < .0001), higher in-hospital mortality (8.4 vs 1.2%; P <.0001), and more acute complications (ie, acute renal failure, fluid and electrolyte disorders, respiratory complications). After adjusting for patients' characteristics and medications, multivariable logistic regression models demonstrated that patients receiving postoperative insulin had nearly 1.6 times the odds of having an infectious complication (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.12-2.2; P = .007) than those who did not. Hyperglycemic patients had 3.5 times the odds of in-hospital mortality (OR, 3.48; 95% CI, 1.78-6.80 [P = .0003]; 2.3% vs 1.2%; P < .001). When stratified by procedure type, patients with hyperglycemia who underwent endovascular repair had nearly 2 times the odds of an infectious complication (OR, 1.85; 95% CI, 0.98-3.51; P = .05) and 7.5 times the odds of in-hospital mortality (OR, 7.54; 95% CI, 1.95-29.1; P = .003). Patients who underwent an open AAA repair and who had hyperglycemia had three times the odds of dying in the hospital (OR, 3.05; 95% CI, 1.29-7.21; P = .01). ConclusionsAmong patients undergoing elective AAA repair, approximately one in six had postoperative hyperglycemia. After AAA repair in patients with and without diabetes, postoperative hyperglycemia was associated with adverse events, including in-hospital mortality and infections. Compared with those who had open surgery, patients undergoing endovascular repair who had postoperative hyperglycemia had greater risk of infection and death. After controlling for insulin administration and postoperative hyperglycemia, a diabetes diagnosis was associated with lower odds of both infection and in-hospital mortality. Our study suggests that hyperglycemia may be used as a clinical marker as it was found to be significantly associated with inferior outcomes after elective AAA repair. This retrospective study, however, cannot imply causation; further study using prospective methods is needed to elucidate the relationship between postoperative hyperglycemia and patient outcomes.

Postoperative insulin secretion is decreased in patients with preoperative insulin resistance

Postoperative hyperglycemia is associated with increased rate of surgical site infection, renal failure, and cardiovascular events. The study of insulin sensitivity state before surgery could help in treating postoperative hyperglycemia and preventing iatrogenic hypoglycemia. We studied the postoperative insulin secretion in patients who have a low insulin sensitivity (IR) before surgery compared to patients with normal preoperative insulin sensitivity (IS). Forty-two consecutive patients, undergoing abdominal surgery, underwent preoperative sequential hyperglycemic-euglycemic clamp (SHEC) in order to measure insulin secretion and to screen patients with low insulin sensitivity (IR) or with normal insulin sensitivity (IS). Patients had been randomized to receive either general anesthesia with epidural or PCA. Postoperative insulin secretion in IR patients is decreased compared to IS (P = 0.059) and to IR before surgery regardless to the type of analgesia (P < 0.001). In the IS group, postoperative insulin secretion depends on type of analgesia. It is increased when using PCA and decreased when using epidural (P < 0.05). Blood glucose increased after surgery in both IS an IR (P < 0.001). Patients with preoperative insulin resistance had a higher glycemia before and after surgery (P < 0.001). Blood glucose levels were comparable between PCA and epidural patients (P = 0.450). Insulin secretion is reduced in IR regardless the type of anesthesia. PCA increases insulin secretion, whereas epidural decreases it in patients with normal insulin sensitivity. These findings implicate that after surgery insulin administration is advisable in patients with preoperative insulin resistance while it should be given cautiously in those with normal preoperative insulin sensitivity.

Clinical significance of perioperative hyperglycemia in bariatric surgery: evidence for better perioperative glucose management

BackgroundUncontrolled hyperglycemia in patients undergoing surgery has been shown to be a risk factor for postoperative complications. ObjectiveTo assess the clinical significance of perioperative hyperglycemia on infectious complications and clinical outcomes in patients undergoing bariatric surgery. SettingSingle academic center. MethodsRetrospective chart review of all patients who underwent primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2013 and 2016 was performed. The association between any elevated perioperative glucose value (hyperglycemia: ≥126 mg/dL) and level of elevation (≥126 or ≥200 mg/dL) with 30-day infectious complications, reoperation, length of hospital stay, and readmission was assessed. Patients who developed early complications (within 3 d of surgery), which could potentially lead to immediate postoperative hyperglycemia, were not included in the analysis. Outcomes of patients with and without diabetes were separately analyzed. ResultsA cohort of 1981 patients was studied, including Roux-en-Y gastric bypass (n = 1171, 59%) and sleeve gastrectomy (n = 810, 41%) patients. In patients with diabetes (n = 751, 38%), perioperative hyperglycemia was independently associated with higher composite infectious complications (defined as presence of any of 6 infectious complications; odds ratio [OR] 3.1, 95% confidence interval [CI] 1.2–8.2, P = .018) and higher readmission rate (OR 2.2, 95% CI 1.1–4.6, P = .027). In patients without diabetes (n = 1230, 62%), 19.2% had perioperative hyperglycemia (≥126 mg/dL). Perioperative hyperglycemia in patients without diabetes was associated with higher composite infectious complications (OR 2.6, 95% CI 1.1–5.5, P = .018) and prolonged length of stay (OR 3.0, 95% CI 1.5–5.9, P = .001). ConclusionsAn elevated perioperative glucose value is adversely associated with infectious complications and key clinical outcomes after bariatric surgery. The increased risk is correlated with the extent of glucose elevation (dose-response relationship). Our findings highlight the importance of glucose control during the perioperative period in bariatric surgical patients.

Determinants, time trends and dynamic consequences of postoperative hyperglycemia in nondiabetic patients undergoing major elective abdominal surgery: A prospective, longitudinal, observational evaluation

In retrospective studies an indisputable causal relationship between hyperglycemia and postoperative infections cannot be entirely disclaimed. We aimed investigate whether the time trends of blood glucose levels in the perioperative period could be a determinant of surgery-related infections. Adult patients without diabetes who were candidates for elective major abdominal operation were prospectively enrolled in a longitudinal, observational multicenter study. The blood glucose level was measured every 6h for 3 days. We calculated the association between blood glucose (BG) levels and the risk of occurrence of surgery-related infections using a joint regression modeling for longitudinal and time-to-event outcomes which accounts for the effect of other risk factors. Between January 2016 and November 2017, we obtained 6078 BG measures distributed on different time-points in 452 patients. There was a nearly 3-fold increased risk of having hyperglycemia, defined as BG≥125mg/dL, if the BG level at admission was >100mg/dL (OR=2.986, P<0.001).The hazard of infection for each 10mg/dL increase of BG levels over time was marginal (HR=1.065, P=0.045). The calculated risk of having an infection was 9.6% for BG going from 110mg/dL during surgery to 84mg/dL at the end of day 3, 10.5% for BG decreasing from 140 to 114, 11.8% for BG decreasing from 180 to 154 and 24.5% for BG increasing from 80 to 145, 24.7% for BG increasing from 110 to 175, and 25.4% for BG increasing from 140 to 205. The time trends of BG - as opposed to the absolute concentration -are major determinants of the risk of postoperative infections.

Nonalcoholic Fatty Liver Disease as a High-Value Predictor of Postoperative Hyperglycemia and Its Associated Complications in Major Abdominal Surgery

For patients undergoing major abdominal operations, acute postoperative hyperglycemia (POHG) is associated with suboptimal outcomes and higher costs of care. This study was performed to determine whether CT-derived indices of nonalcoholic fatty liver disease (hepatic steatosis) or visceral adiposity may serve as predictors of POHG and its consequences in such patients. We reviewed records and preoperative abdominal CT images of 129 patients undergoing complex open ventral hernia repair (cVHR) from 2012 to 2016, with 90-day follow-up. Univariate and multivariate regressions were performed to estimate associations between CT-detected steatosis or visceral adiposity with POHG (serum glucose > 140 mg/dL within 48 hours), surgical site occurrence (SSO), and subsequent interventions (SSO-I). Type-2 diabetes (T2D) was present in 23% and POHG in 52%; SSO events occurred in 28% and SSO-I in 21%. Highest-effect associations with POHG were observed for T2D (odds ratio [OR] 21.54; 95% CI 4.85, 95.58), hepatic steatosis (OR 2.20, 95% CI 1.07, 4.52), and waist circumference-to-height ratio (WCHR > 0.65; OR 2.37, 95% CI 1.16, 4.83). After multivariate analysis, the effects of T2D (OR 16.73; CI 5.42, 73.87; p < 0.0001) and steatosis (OR 2.55; CI 1.17, 5.69; p= 0.02) remained independently associated with POHG. Independent associations with SSO were observed for steatosis (OR 3.31; CI 1.41, 8.06; p= 0.007), POHG (OR 2.85; CI 1.17, 7.38; p= 0.024), and WCHR (OR 2.68; CI 1.11, 6.85; p= 0.03). Image-based indices of chronic metabolic disturbance in the liver and adipose tissues may offer novel opportunities for identifying patients at risk for POHG and those who would benefit from preoperative metabolic optimization.

Incidence and management of postoperative hyperglycemia in patients undergoing insulinoma resection.

It has been proposed that rebound hyperglycemia after resection of insulinoma indicates a biochemical cure. However, there is scant objective data in the literature on the rate and need for intervention in hyperglycemia in patients undergoing resection of insulinoma. The goal of our study was to evaluate the rate of postoperative hyperglycemia, any predisposing factors, and the need for intervention in a prospective cohort study of all patients undergoing routine glucose monitoring. A retrospective analysis of 33 patients who had an insulinoma resected and who underwent routine postoperative monitoring of blood glucose (every hour for the first six hours then every four hours for the first 24 h) was performed. Hyperglycemia was defined as glucose greater than 180 mg/dL (10 mmol/l). Twelve patients (36%) developed hyperglycemia within 24 h (range 1-16 h). In patients with hyperglycemia, the mean maximum plasma glucose level was 221.5 mg/dL (range 97-325 mg/dL) (12.3 mmol/l), and four (33%) patients were treated with insulin. There was no significant difference in age, gender, body mass index (BMI), tumor size, biochemical profile, or surgical approach and extent of pancreatectomy between patients who developed hyperglycemia and those who did not. Pre-excision and post-excision intraoperative insulin levels were evaluated in 14 of 33 patients. The percentage decrease of the intraoperative insulin levels was not significantly different between patients who developed hyperglycemia and those who did not. All patients with postoperative hyperglycemia had normalization of their glucose levels, and none were discharged on anti-hyperglycemic agents. Hyperglycemia is common after insulinoma resection, and a subset of patients require transient treatment with insulin.

Kinetic, determinants, and consequences of postoperative hyperglycemia in nondiabetic patients undergoing major elective abdominal surgery: A prospective, longitudinal, observational, multicenter evaluation

Kinetic, determinants, and consequences of postoperative hyperglycemia in nondiabetic patients undergoing major elective abdominal surgery: A prospective, longitudinal, observational, multicenter evaluation

Post-operative stress hyperglycemia is a predictor of mortality in liver transplantation

BackgroundA significant association is known between increased glycaemic variability and mortality in critical patients. To ascertain whether glycaemic profiles during the first week after liver transplantation might be associated with long-term mortality in these patients, by analysing whether diabetic status modified this relationship.MethodObservational long-term survival study includes 642 subjects undergoing liver transplantation from July 1994 to July 2011. Glucose profiles, units of insulin and all variables with influence on mortality are analysed using joint modelling techniques.ResultsPatients registered a survival rate of 85% at 1 year and 65% at 10 years, without differences in mortality between patients with and without diabetes. In glucose profiles, however, differences were observed between patients with and without diabetes: patients with diabetes registered lower baseline glucose values, which gradually rose until reaching a peak on days 2–3 and then subsequently declined, diabetic subjects started from higher values which gradually decreased across the first week. Patients with diabetes showed an association between mortality and age, Model for End-Stage Liver Disease score (MELD) score and hepatitis C virus; among non-diabetic patients, mortality was associated with age, body mass index, malignant aetiology, red blood cell requirements and parenteral nutrition. Glucose profiles were observed to be statistically associated with mortality among patients without diabetes (P = 0.022) but not among patients who presented with diabetes prior to transplantation (P = 0.689).ConclusionsGlucose profiles during the first week after liver transplantation are different in patients with and without diabetes. While glucose profiles are associated with long-term mortality in patients without diabetes, after adjusting for potential confounding variables such as age, cause of transplantation, MELD, nutrition, immunosuppressive drugs, and units of insulin administered, this does not occur among patients with diabetes.