Preoperative Blood Glucose Levels Research Articles

High pre-operative fasting blood glucose levels predict a poor prognosis in patients with pancreatic neuroendocrine tumour.

Hyperglycaemia has been indicated as a pro-tumoural factor; however, the prognostic role of diabetes mellitus (DM) in pancreatic neuroendocrine tumours (panNETs) remains ambiguous, partly due to the effects of anti-diabetic drugs. We hypothesise that the blood sugar level per se affects the outcome of panNETs, and thus, we investigated the prognostic significance of the fasting blood glucose (FBG) level in resected panNET patients with no pre-existing DM. A retrospective cohort study comprising 201 patients with radically resected non-functional panNETs was conducted. A total of 164 patients without pre-existing DM were further studied. An FBG level greater than 5.6 mmol/L was defined as high (otherwise, normal). Survival was evaluated using Kaplan-Meier methods and log-rank tests. Multivariate analyses for survival were performed using the Cox regression model. High FBG levels were significantly associated with poor overall survival (OS; p = 0.019) and recurrence-free survival (RFS; p = 0.011) in resected patients with panNET who had no pre-existing DM. The multivariable-adjusted hazard ratios (HRs) for mortality and recurrence comparing patients with high and normal FBG levels were 12.19 (95% confidence interval (CI) = 1.15-128.78, p = 0.038) and 2.43 (95% CI = 1.03-5.72, p = 0.042), respectively. A pre-operative FBG level greater than 5.6 mmol/L is associated with poor OS and RFS metastasis for patients with panNET who undergo radical surgical resection.

Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis

BackgroundModern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient. AimTo compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant. MethodsWe systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher’s exact and Pearson’s chi-square tests, and logistic regression modeling was performed to account for covariates. OutcomesThe main outcome measures of this study were postoperative infection, explantation, and revision rates. ResultsOf the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P = .004], [1.1% vs 8.3%; P < .001], and [2.5% vs 12.5; P < .001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P = .049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P = .057). Including antifungals in the dipping solution did not affect infection (P = .414), explantation (P = .421), or revision (P = .328) rates. Clinical ImplicationsVancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision. Strengths and LimitationsData were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables. ConclusionThe use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection.Towe M, Huynh LM, Osman MM, et al. Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis. J Sex Med 2020;17:2077–2083.

Do preoperative glycosylated hemoglobin (HbA1C) and random blood glucose levels predict wound healing complications following exodontia in type 2 diabetes mellitus patients?—a prospective observational study

Many dental surgeons consider a type 2 diabetic patient to be at higher risk for wound healing complications following exodontia. Random blood glucose (RBG) and glycosylated hemoglobin (HbA1C) values help the surgeon determine the glycemic control and assess if the patient can undergo the surgical procedure. The purpose of this study was to analyze if preoperative HbA1C and RBG testing could predict the risk of wound healing and infectious complications in type 2 DM patients undergoing exodontia in an office setting. This prospective observational study included 133 type 2 diabetic patients and age- and gender-matched non-diabetic patients undergoing exodontia. Preoperative HbA1C values and random blood glucose levels were obtained for patients in both groups. Wound healing and infectious complications and additional interventions performed were recorded. Duration of diabetes ranged from 1 to 25 years. 80.5% of diabetics were treated with oral hypoglycemics. A vast majority of patients in both groups underwent extraction of only a single tooth. There was no significant difference in non-infectious complications between the two groups. The absolute risk of infectious complications in diabetics was 10.5% compared to a 6.8% risk among the control group. Age, RBG values, HbA1C, duration of DM, and number and nature of exodontia performed did not show any statistical significance. This study observed a slight, but not statistically significant increase in the risk of infectious complications in type 2 DM patients undergoing exodontia. Surgical site infections were amenable to surgical drainage with or without oral antibiotics on an outpatient basis with favorable healing outcomes. The RBG and HbA1C values were not significantly associated with risk of infectious complications. Resorting to prophylactic antibiotics and warning about possible adverse healing for routine exodontia in type 2 DM patients is unnecessary.

Preoperative Blood Glucose Level Predicts Postsurgical Gastroparesis Syndrome after Subtotal Gastrectomy: Development of an Individualized Usable Nomogram.

Background Postsurgical gastroparesis syndrome (PGS) after subtotal gastrectomy imposes significant social and economic burdens. We aimed to investigate the relationship between preoperative blood glucose level and PGS and develop a nomogram for individualized prediction. Patients and Methods. We retrospectively analyzed 633 patients with gastric cancer who underwent subtotal gastrectomy. Preoperative blood glucose levels were evaluated via receiver operating characteristic (ROC) curve analysis. Chi-squared tests and multivariable logistic regression analyses were used to develop a predictive model for PGS, presented as a nomogram, which was assessed for its clinical usefulness. Results Thirty-eight of 633 patients were diagnosed with PGS. Based on the ROC curve analysis, the preoperative blood glucose cutoff value for PGS was 6.25 mmol/L. The predictors of PGS included preoperative hyperglycemia (odds ratio (OR) 2.3, P = 0.03), body mass index (BMI; OR 0.21, P = 0.14 for BMI < 18.5 and OR 3.0, P = 0.004 for BMI > 24), and the anastomotic method (OR 7.3, P = 0.001 for Billroth II and OR 5.9, P = 0.15 for Roux-en-Y). The predictive model showed good discrimination ability, with a C-index of 0.710, and was clinically useful. Conclusions Preoperative hyperglycemia effectively predicts PGS. We present a nomogram incorporating the preoperative blood glucose level, BMI, anastomotic method, and tumor size, for individualized prediction of PGS.

Investigation of fluctuations in blood glucose level due to dietary restrictions during impacted mandibular third molar extraction under intravenous sedation: effect of perioperative glucose administration

ObjectiveWe aimed to investigate the usefulness of glucose administration for maintaining perioperative glycemic control in patients with dietary restrictions during 4 h prior to impacted mandibular third molar extraction under intravenous sedation.MethodsFifty-four individuals scheduled to undergo extraction of impacted mandibular third molars under intravenous sedation, with preoperative blood glucose levels (GL) of 70–110 mg/dL, were evaluated and divided into 3 groups (n = 18 each): control group receiving glucose-free sodium lactate Ringer’s solution, perioperative GL group receiving 100 mL of 5% glucose solution immediately after local anesthesia, and postoperative GL group receiving 100 mL of 5% glucose solution immediately after surgery completion. Blood glucose levels, systolic blood pressure, diastolic blood pressure, and heart rate were measured.ResultsGlucose levels of those in the control and perioperative GL groups decreased within the standard range 90 min after surgery, compared with the preoperative blood glucose level. However, in the postoperative GL group, glucose levels were similar to the preoperative levels. Systolic and diastolic blood pressure and heart rate were not affected by glucose administration, and sedation could be maintained without an invasive procedure.ConclusionsFollowing a restriction on eating and drinking 4 h prior to surgery, the blood glucose level gradually decreased in the perioperative period but remained within the reference range until 90 min following surgery. The administration of 100 mL 5% glucose solution immediately after surgery was sufficient for the prevention of postoperative hypoglycemia. This approach may be useful for perioperative glycemic control during third molar extraction.

Immediate preoperative blood glucose and hemoglobin a1c levels are not predictive of postoperative infections in diabetic men undergoing penile prosthesis placement.

Defining the risks associated with diabetes mellitus in patients undergoing penile prosthesis implantation remains controversial. Our study aims to assess whether preoperative hemoglobin a1c and preoperative blood glucose levels are associated with an increased risk for postoperative infection in diabetic men. We performed a retrospective review of 932 diabetic patients undergoing primary penile prosthesis implantation from 18 high-volume penile prosthesis implantation surgeons throughout the United States, Germany, Belgium, and South Korea. Preoperative hemoglobin a1c and blood glucose levels within 6 h of surgery were collected and assessed in univariate and multivariate models for correlation with postoperative infection, revision, and explantation rates. The primary outcome is postoperative infection and the secondary outcomes are postoperative revision and explantation. In all, 875 patients were included in the final analysis. There were no associations between preoperative blood glucose levels or hemoglobin a1c levels and postoperative infection rates; p = 0.220 and p = 0.598, respectively. On multivariate analysis, a history of diabetes-related complications was a significant predictor of higher revision rates (p = 0.034), but was nonsignificant for infection or explantation rates. We conclude preoperative blood glucose levels and hemoglobin a1c levels are not associated with an increased risk for postoperative infection, revision, or explantation in diabetic men undergoing penile prosthesis implantation.

028 Adherence to the AUA Penile Prosthesis Antibiotic Prophylaxis Guidelines in Diabetic Patients is Associated with Significantly Higher Risks of Device Infection

The most devastating complication following penile prosthesis (PP) implantation is an infection requiring device explantation. Current AUA guidelines recommend antibiotic prophylaxis before PP implantation with an aminoglycoside and either a 1st/2nd generation cephalosporin or vancomycin. We conducted a multi-institutional study to examine infection rates in diabetic patients undergoing PP implantation with different prophylactic antibiotic regimens, and compared outcomes based on adherence to AUA guidelines. Between April 2003 and August 2018, data was collected from 18 different institutions, and charts of 923 patients with diabetes receiving primary PP implantation were reviewed. Perioperative antibiotic regimen was recorded for each patient and the primary outcome was post-operative infection rates, the secondary outcomes were explantation and revision rates. Patients had a median follow up time of 8 months (range: 0 – 157). Patients were included in the analysis only if they had complete information regarding perioperative antibiotics and outcomes. Univariate comparisons of proportions were completed for rates of infection between different antibiotic regimens. Multivariate analysis controlling for immediate pre-operative blood glucose levels, Hemoglobin A1c, age, diabetes-related complications, and surgical approach was completed for rates of infection, revision, and explantation rates.

Preoperative and postoperative risk factors in laparoscopic cholecystectomy converted to open surgery.

Laparoscopic cholecystectomy (LC) is nowadays the gold standard in the surgical treatment of cholelithiasis and gallbladder diseases. But sometimes it may be inevitable to convert it to open surgery to safely end the procedure. In this study, we aimed to investigate the risk factors for conversion to open surgery from LC. The records of patients that underwent LC in Malatya State Hospital (Malatya, Turkey) between January 2013 and May 2014 were prospectively examined. One hundred and forty-five patients were involved in this study. The patients were divided into 2 groups: LC patients and patients converted to open surgery. For the patients in both groups, the preoperative age, gender, body mass index (BMI), disease history, previous abdominal operations, and preoperative laboratory findings were recorded, as well as the fact if the abdominal ultrasonography (US) and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Of 145 patients involved in this study, 127 (87.5%) were female and 18 (12.5%) were male; their mean age was 46.54 years. Nineteen of the patients were operated on after ERCP due to acute cholecystitis and 6 patients were operated on after ERCP due to choledocholithiasis. In 134 of the patients (92.4%), the operations were completed laparoscopically, while the process was converted to open surgery in 11 cases (7.6%). Male gender, chronic disease history, normal BMI level, increased thickness of the gallbladder wall, increased preoperative blood glucose level, leukocytosis, preoperative ERCP history, grade 3 or 4 (Blauer scoring system) adhesions determined during the operation, and multiple stone presence in the bladder were found to be statistically significant risk factors for conversion to open surgery. Patients in the risk group should be informed by experienced laparoscopic surgeons about the potential conversion to open surgery and decision on such conversion should be made when necessary.

352 - Immediate preoperative blood glucose and Hemoglobin A1c levels are not predictive of post-operative infections in diabetic men undergoing penile prosthesis placement

352 - Immediate preoperative blood glucose and Hemoglobin A1c levels are not predictive of post-operative infections in diabetic men undergoing penile prosthesis placement

Laparoscopic loop duodenaljejunal bypass with sleeve gastrectomy in type 2 diabetic patients

BackgroundLaparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a new metabolic procedure. Our initial data on type 2 diabetes (T2D) remission after LDJB-SG were promising. ObjectivesThe aim of this study was to look at our intermediate outcomes after LDJB-SG. SettingAn academic medical center. MethodsA prospective analysis of T2D patients who underwent LDJB-SG between October 2011 and October 2014 was performed. Data collected included baseline demographic, body mass index, fasting blood glucose, glycosylated hemoglobin, C-peptide, resolution of co-morbidities, and postoperative complications. ResultsA total of 163 patients with minimum of follow-up >1 year were enrolled in this study (57 men and 106 women). The mean age and body mass index were 47.7 (±10.7) years and a 30.2 (±5.1) kg/m2, respectively. There were 119 patients on oral hypoglycemic agents only, 29 patients were on oral hypoglycemic agents and insulin, 3 patients were on insulin only, and the other 12 patients were not on diabetic medication. Mean operation time and length of hospital stay were 144.7 (± 45.1) minutes and 2.4 (± 1.0) days, respectively. Seven patients (3.6%) needed reoperation due to bleeding (n = 1), anastomotic leak (n = 2), sleeve strictures (n = 2), and incisional hernia (n = 2). At 2 years of follow-up, there were 56 patients. None of the patients were on insulin and only 20% of patients were on oral hypoglycemic agents. Mean body mass index significantly dropped to 22.9 (±5.6) kg/m2 at 2 years. The mean preoperative fasting blood glucose, glycosylated hemoglobin, and C-peptide levels were 174.7 mg/dL (± 61.0), 8.8% (±1.8), and 2.6 (±1.7) ng/mL, respectively. The mean fasting blood glucose, glycosylated hemoglobin, and C-peptide at 2 years were 112.5 (±60.7) mg/dL, 6.4% (±2.0), and 1.5 (±0.6) ng/mL, respectively. No patient needed revisional surgery because of dumping syndrome, marginal ulcer, or gastroesophageal reflux disease at the last follow up period. ConclusionAt 2 years, LDJB-SG is a relatively safe and effective metabolic surgery with significant weight loss and resolution of co-morbidities.

Evaluating patient preparedness for cataract surgery and satisfaction with preoperative care

ObjectiveTo evaluate preoperative preparedness and patient satisfaction after implementation of the Cataract Screening Preprocedural Questionnaire (CSPQ) at Hamilton Regional Eye Institute. DesignSingle-centred, prospective, cross-sectional study. Participants/MethodsOne-hundred fifty-one adult patients undergoing elective cataract surgery completed the CSPQ questionnaire. Based on the responses, patients were triaged to the preoperative anaesthesia clinic or booked directly for surgery. Outcome measures included anxiety level, delays or cancellations in surgery, preoperative blood pressure, glucose levels, and satisfaction with the quality of preoperative instructions provided. Results were compared between patients who attended and those who bypassed the preoperative anaesthesia clinic. ResultsOf the study population, 87 patients were female (57.6%) and the mean age was 72.0 ± 10.5 years. Only 11 patients (7.43%) were referred for preoperative consultation. Patients reported receiving preoperative instructions via handouts (94%) and verbally in combination with handouts (59.33%). Patients felt that adequate information was provided regarding preoperative medications (96.69%), eye drops (99.34%), fasting guidelines (98.68%), arrival time (99.34%), and instructions for accompaniment/drivers postoperatively (100%). All patients were compliant with the fasting guidelines. Patient satisfaction with the information received regarding cataract surgery and anaesthesia were 4.39 ± 0.88 and 3.80 ± 0.95, respectively. There was no difference in the anxiety level between patients who attended and those who bypassed the preoperative clinic (4.09 ± 2.92 and 5.18 ± 2.57, p = 0.14). There were no cancellations, delays, or immediate postoperative systemic complications. ConclusionsThe CSPQ model can be effectively used to streamline the preoperative preparation of patients for cataract surgery while maintaining a high degree of patient satisfaction with the perioperative experience.

Importance of Hemoglobin A1c Levels for the Detection of Post-Surgical Infection Following Single-Level Lumbar Posterior Fusion in Patients with Diabetes.

ObjectiveSeveral studies have reported that patients with diabetes mellitus (DM) are vulnerable to infection. However, the mechanism underlying this remains unclear. We hypothesized that preoperative blood glucose levels in patients with DM may be a risk factor for surgical site infection (SSI). We aimed to investigate the relationship between hemoglobin A1c (HbA1c) level and SSI incidence following single-level spinal fusion surgery.MethodsPatients with DM who underwent single-level lumbar posterior fusion surgery were retrospectively reviewed. Ninety-two patients were included and classified into the SSI and SSI-free groups. Clinical data with demographic findings were obtained and compared. The HbA1c cut-off value was defined using receiver operating characteristic (ROC) and area under the curve (AUC) analyses, which showed a significantly increased SSI risk. Potential variables were verified using multiple logistic regression analysis.ResultsAmong the enrolled patients, 24 had SSI and 68 did not within 1 year. The preoperative HbA1c level was higher in patients with SSI (6.8%) than in the non-infected patients (6.0%; p=0.008). ROC analysis showed that if the HbA1c level is higher than 6.9%, the risk of SSI significantly increases (p=0.003; AUC, 0.708; sensitivity, 62.5%; specificity, 70.6%). The preoperative HbA1c level was significantly correlated with SSI incidence, after adjusting for potential variables (p=0.008; odds ratio, 4.500; 95% confidence interval, 1.486–13.624).ConclusionThe HbA1c level, indicating glycemic control, in patients with DM may be a risk factor for SSI in single-level lumbar spine posterior fusion.

Implementation of a Standardized Preoperative Diabetes Medication Guideline and its Effect on Day of Procedure Blood Glucose Levels

The purpose of this project was to determine the effect of implementation of a preoperative diabetes medication management guideline on day of procedure blood glucose (BG) levels. This project was designed as pre- and postimplementation process improvement project based on the Iowa Model of evidence-based practice. Anesthesia providers were surveyed for knowledge and confidence before and following education. Surgical patients with diabetes were provided instructions for all classes of prescribed diabetes medications. Day of procedure BG levels were compared prior to and following the guideline implementation. Provider knowledge scores increased 4.5 points (95% confidence interval [CI] 3.2, 5.8) and confidence improved 31.3 percentage points (95% CI 20.8, 41.7). Mean BG level was 132.3 (SD 37.5) before implementation and 130.4 (SD 44.7) after implementation. The project resulted in significant gains in provider knowledge and confidence, but no significant difference in preoperative BG levels following implementation of the guideline.

Surgical Outcome in Adolescents and Adults With Anomalous Left Coronary Artery From Pulmonary Artery

The outcomes of different repair strategies of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in adolescent and adult patients are uncertain. The long-term outcomes of reimplantation and Takeuchi repair were compared in this study. We conducted a retrospective review of data collected from patients receiving ALCAPA repair at our institute from January 2005 to December 2016. Short- and long-term outcomes of reimplantation and Takeuchi repair were compared. A total of 50 consecutive patients underwent ALCAPA repair, with an average age of 31.6 ± 15.6 years and 66% women. No significant differences were found in short-term outcomes between the 2 groups. However, at a median of 65.7 months' follow-up, the major adverse cardiovascular event (MACE) (including all-cause death, admission due to heart failure, new-onset acute myocardial infarction, and repeated revascularization) rate of the Takeuchi repair group was significantly lower than that of the reimplantation group (hazard ratio, 0.21; 95% confidence interval, 0.04 to 0.97). Furthermore, the preoperative glucose level was significantly associated with increased MACE rate (hazard ratio, 10.82; 95% confidence interval, 1.20 to 97.54). Left ventricular end-diastolic diameter and ejection fraction significantly improved in both groups. However, mitral valvuloplasty did not predict long-term recovery of left ventricular function. Although short-term outcomes were satisfactory in both groups, a higher MACE rate was observed in reimplantation group than Takeuchi repair group; mitral valvuloplasty was not significantly associated with improved prognosis and left ventricular reverse remodeling. Elevation of preoperative blood glucose level was significantly associated with increasing long-term MACE rate.

Blisters in Ankle Fractures: A Retrospective Cohort Study

The most frequent postoperative complications after an ankle fracture are usually skin related. We present the results of a retrospective study of 112 patients with ankle fracture who had undergone open reduction and internal fixation from January 2014 to December 2014. The following features were analyzed: patient comorbidities, fracture type, the presence of an open fracture or fracture-dislocation, timing and duration of surgery, preoperative glucose level, and short-term complications (i.e., blisters, wound dehiscence, deep and superficial infections, and reintervention). The mean age of the patients was 50.38 years. Fracture blisters were present in 20.5% of the cases. The operative time was 75.74 ± 25.09 minutes for patients with blisters and 64.48 ± 19.73 minutes for patients without blisters (p = .023). The preoperative blood glucose levels were 122.96 ± 28.46 g/dL in the patients with blisters and 106.70 ± 21.32 g/dL in the patients without blisters (p = .003). No statistically significant differences were observed between the patients who had undergone surgery <24 hours after injury and those who had done so >24 hours after injury. In conclusion, the presence of postoperative blisters in patients with ankle fractures was associated with prolonged surgical procedures and high serum glucose levels.

Rationalization, Development, and Implementation of a Preoperative Diabetes Optimization Program Designed to Improve Perioperative Outcomes and Reduce Cost.

Diabetes is an increasingly common medical condition affecting ∼29 million people (8 million of whom are undiagnosed), or 9% of the U.S. population. The estimated health expenditures to prevent and treat diabetes and associated direct and indirect complications totaled $245 billion in 2012, and this cost is on a trajectory to double by 2030 (1,2). An estimated 25% of patients with diabetes will require surgery (3). Twenty-eight percent of patients with diabetes are unaware that they have the disease (2). Furthermore, 5–10% of patients presenting for surgery are found to have previously unrecognized diabetes (4,5). This is particularly important because patients who are unaware of their diabetes have higher preoperative blood glucose levels (4) and a higher risk of perioperative mortality compared to patients who are aware of their diabetes (5). Diabetes is a well-known risk factor for postoperative infection, acute renal failure, ileus, and prolonged hospital stay (6–9). Poor preoperative glycemic control portends poor intraoperative glycemic control, which is an established risk factor for perioperative morbidity (10,11). Surgical patients with perioperative hyperglycemia (with and without underlying diabetes) have a greater risk for infection and related adverse outcomes after surgery compared to patients without hyperglycemia. Patients with diabetes are more prone to these surgical complications due to the microangiopathy (e.g., nephropathy and neuropathy) and macroangiopathy (e.g., atherosclerosis) intrinsic to the disease and also have mortality rates significantly greater than those of patients without diabetes (12–16). When patients with poorly controlled diabetes present for surgery, they impose a significant financial health resource burden, including prolonged ventilator dependence, longer hospital stay, and greater postoperative loss of productivity. As the prevalence of diabetes increases, optimal screening, management, and timing of elective surgery for patients with diabetes has become a matter of increasing …

A Cross-sectional Observational Analysis of Preoperative Blood Glucose Levels in Nondiabetic Patients presenting for Surgery

ABSTRACT Introduction Abnormal blood glucose levels alter the course and result of surgery. This study aims to quantify the incidence of hypoglycemia or hyperglycemia in the preoperative period and to assess the impact of duration of nil per os (NPO), age, intravenous fluids (IVFs), blood transfusion, severity of pain and anxiety, and steroid or antibiotic administration on preoperative blood glucose levels in nondiabetic patients. Materials and methods The NPO duration, age, IVF, blood transfusion, pain and anxiety score, steroid and antibiotic administration were noted in 1,000 nondiabetic patients presenting for both elective and emergency surgery. Blood glucose level was measured before induction of anesthesia by capillary finger-prick method. The values of blood glucose levels were analyzed for correlation with above-mentioned parameters. Results Overall incidence of hypoglycemia was found to be 23.3%. About 27.2% of patients including 34.95% children posted for elective surgery and 33.37% of patients including 8.73% children posted for emergency surgery group were hypoglycemic. The incidence of hyperglycemia was 1.51 and 1.08% for adults in elective and emergency category respectively. Age showed widely varied association to preoperative blood glucose levels; blood glucose levels increased with age in male patients, with patients aged between 18 and 40 years admitted for emergency surgery (p = 0.006), but decreased with age in patients older than 60 years irrespective of gender and type of surgery (p = 0.014). The preoperative blood glucose levels increased with higher preoperative pain and anxiety (p = 0.05) and administration of steroids (p = 0.00043). Similarly, with increase in duration of NPO, preoperative blood glucose levels decreased in adult females (p = 0.000) and males over 40 years (p = 0.049), both admitted for emergency surgery. Only preoperative normal saline (NS; p = 0.001), 6% hydroxyethyl starch (HES; p = 0.043), Isolyte P (p = 0.000), and blood transfusion (p = 0.05) showed significant correlation. Conclusion Preoperative blood glucose monitoring is recommended mandatorily for all patients posted for emergency surgery. It is also recommended for elective pediatric and geriatric surgery patients, patients with high anxiety and/or pain, increased NPO duration, and preoperative administration of steroid, NS, 6% HES, or blood. How to cite this article Pattajoshi S, Nerurkar AA, Tendolkar BA. A Cross-sectional Observational Analysis of Preoperative Blood Glucose Levels in Nondiabetic Patients presenting for Surgery. Res Inno in Anesth 2017;2(2):29-33.

Lower extremity weakness is associated with elevated blood and cerebrospinal fluid glucose levels following multibranched endovascular aortic aneurysm repair

ObjectiveHyperglycemia is associated with worsened clinical outcomes after central nervous system injury. The purpose of this study was to examine the association between lower extremity weakness (LEW) and the glucose levels of blood and cerebrospinal fluid (CSF) in patients undergoing multibranched endovascular aneurysm repair (MBEVAR) of thoracoabdominal and pararenal aortic aneurysms. MethodsBlood and CSF samples were collected preoperatively, immediately after aneurysm repair, and on postoperative day 1 in 21 patients undergoing MBEVAR. Data on demographics, operative repair, complications, and outcomes were collected prospectively. ResultsThere were 21 patients who underwent successful MBEVAR. Two patients had pre-existing paraplegia from prior open aortic surgery and were excluded from the current analysis. The mean age was 73 ± 8 years, and 15 of 19 (79%) were men. In the postoperative period, 7 of 19 (37%) patients developed LEW. This was temporary in 5 of 19 (26%) patients and permanent in 2 of 19 (11%) patients. The LEW group was older than the non-LEW group (77 ± 6 vs 70 ± 9 years, respectively; P = .10), had a lower preoperative glomerular filtration rate (58.6 ± 18.5 vs 71.4 ± 23.5 mL/min per 1.73 m2; P = .24), and was more likely to be taking a statin (100% vs 67%, respectively; P = .13), but these did not reach statistical significance. There was no significant difference in the prevalence of diabetes mellitus, hypertension, coronary artery disease, lung disease, or peripheral artery disease between the LEW and non-LEW groups. There was also no difference in operative time, blood loss, contrast material volume, or fluoroscopy times between the two groups. Preoperative blood and CSF glucose levels were similar in those with and without LEW. During the postoperative period, glucose values in the blood and CSF were significantly higher in those patients who developed LEW compared with those who did not develop LEW. In all patients with LEW, the elevation in the blood or CSF glucose level preceded the development of LEW. In a multivariable logistic regression model, CSF glucose concentration on postoperative day 1 was significantly and independently associated with the development of LEW (odds ratio, 2.30 [1.03-5.14] per 10 mg/dL increase in CSF glucose; P = .04). ConclusionsElevated blood glucose and CSF glucose levels are associated with postoperative LEW in patients undergoing MBEVAR. The protective effect of euglycemia deserves further study in patients at risk for spinal cord ischemia.

The Impact of Diabetes Mellitus on Wound Healing in Breast Reconstruction.

Although diabetes mellitus (DM) is a known risk factor for surgical complications in general, there is little published evidence to establish such an effect among patients undergoing breast reconstruction (BR). The purpose of this study was to assess the impact of DM on complications in patients undergoing postmastectomy BR. Patients who underwent BR at our institution from November 2002 to November 2012 were identified. Clinical and demographic data of patients with type 1 or type 2 DM were reviewed. Complications occurring within 60 days of surgery were compared between diabetic and nondiabetic patients for both autologous and nonautologous reconstruction types. A total of 1371 BR were performed in 1035 patients. There were 877 (64.0%) autologous reconstructions and 494 (36.0%) implant-based reconstructions. Patients with DM (n = 64) had significantly higher preoperative blood glucose levels (137.5 vs 100.1, P < 0.05). Postoperatively, DM patients reconstructed with implants had a significantly higher incidence of delayed wound healing (22.2% vs 9.7%; P = 0.04). This was not observed in patients with DM reconstructed with autologous tissue (7.4% vs 6.6%; P = 0.70). Diabetic patients had a significantly higher incidence of hypertension and were older than nondiabetic patients. To control for these variables and other potential confounders, multiple logistic regression analysis was performed. Again, diabetic patients had a significantly higher incidence of delayed wound healing following implant-based reconstruction (odds ratio, 2.52, 95% confidence interval = 1.2-6.2) but not autologous reconstruction (odds ratio, 0.97; 95% confidence interval = 0.2-4.6). Diabetes heightens the risk of wound healing complications among patients undergoing implant-based reconstruction.

Postoperative hyperglycemia after 4- vs 8-10-mg dexamethasone for postoperative nausea and vomiting prophylaxis in patients with type II diabetes mellitus: a retrospective database analysis

Study objectiveThe study objective is to compare change in postoperative blood glucose from preoperative values in patients with type II diabetes mellitus receiving 4- or 8-10-mg dexamethasone for postoperative nausea and vomiting prophylaxis. DesignThis is a retrospective database study. SettingThe setting is at an academic university medical center. PatientsThere are 1037 adult patients, American Society of Anesthesiologists physical status I-IV, with type II diabetes mellitus, undergoing elective surgery between January 1, 2006, and March 31, 2012, and who were hospitalized for at least 24 hours. InterventionsThe interventions are dexamethasone 4 or 8-10 mg for postoperative nausea and vomiting prophylaxis. MeasurementsAge, sex, American Society of Anesthesiologists class, height, weight, body mass index, surgery date, type and duration of surgery, hemoglobin A1c (HbA1c) within 180 days of surgery, type of anesthesia, preoperative blood glucose in the preoperative holding area, maximum blood glucose in the postanesthesia care unit (PACU) and first 24 hours postoperatively, and insulin requirements intraoperatively and in PACU. Main resultsIn unadjusted analysis, the 8-10-mg dose was associated with greater (mean ± SD) increase in blood glucose compared with the 4-mg dose in PACU (58 ± 50 vs 43 ± 45 mg/dL, P < .0001) and over 24 hours (101 ± 71 vs 67 ± 65 mg/dL, P < .0001). In the multivariable model, predictors of blood glucose increase in PACU included dexamethasone dose (P < .0001), preoperative serum glucose (P < .0001), duration of surgery (P < .0001), and total dose of insulin (P < .0001). Over 24 hours, the significant predictors of glucose increase included dexamethasone dose (P < .0001), preoperative blood glucose level (P < .0001), duration of surgery (P < .0001), year of surgery (P = .04), and neurosurgical procedures (P = .02). This model estimates the increase in postoperative glucose to be 25 mg/dL higher over 24 hours with dexamethasone 8-10 mg than with 4 mg (95% confidence limits, 18-32 mg/dL). ConclusionsDexamethasone 8-10 mg is associated with a significantly greater perioperative increase in blood glucose compared with a 4-mg dose.