Incidence and risk factors of intraoperative hyperglycemia in non-diabetic patients: a prospective observational study

Abstract

Background Intraoperative hyperglycemia has been associated with multiple postoperative complications such as surgical site infection, myocardial infarction, stroke, and death. These complications are not confined to only diabetic patients. However, the incidence of intraoperative hyperglycemia in non-diabetic patients has not been fully elucidated. Additionally, these patients’ risk factors were not well established in previous studies. Methods Four hundred forty non-diabetic patients who underwent intermediate- to high-risk surgery were included in the study. We prospectively measured the capillary blood glucose level in all patients during surgery. The incidence of intraoperative hyperglycemia was defined as at least one episode of blood glucose level of more than 180 mg/dL. Risk factors for hyperglycemia were assessed using multivariable logistic regression analysis. Results Sixty-five (14.7%) patients developed hyperglycemia during surgery. The independent risk factors for intraoperative hyperglycemia were an American Society of Anesthesiologists status ≥ 3 (odds ratio [OR] 6.09, 95% confidence interval [CI]: 2.67–13.89, p < 0.001), preoperative impaired fasting blood sugar (OR 2.28, 95%CI:1.13–4.61, p = 0.021), duration of anesthesia ≥ 3 h (OR 4.06, 95%CI: 1.23–13.45, p = 0.021), intraoperative hypotension (OR 5.37, 95%CI: 2.35–12.29, p < 0.001), intraoperative blood transfusion (OR 4.35, 95%CI: 2.15–8.79, p < 0.001), and steroid use (OR 2.39, 95%CI: 1.20–4.76, p = 0.013). Surgical site infection was higher in patients with intraoperative hyperglycemia compared with patients without intraoperative hyperglycemia (4 [6.1%] vs. 6 [1.6%], respectively, p = 0.035). Conclusion The incidence of intraoperative hyperglycemia was significant in non-diabetic patients during intermediate- to high-risk surgery. Risk factors should be identified to prevent intraoperative hyperglycemia. Trial registration The study was prospectively registered at https://www.thaiclinicaltrials.org (TCTR20191114001).

Effect of Sevoflurane, Isoflurane, and Desflurane on the Random Blood Glucose Levels in Non-diabetic Patients Undergoing General Anesthesia: A Randomized, Single-Blind Study

“…Perioperative glycemic control plays a significant role in improving surgical outcomes and decreasing morbidity both in patients with or without diabetes mellitus and even in non-cardiac surgeries [6,7]. Nevertheless, intraoperative increases in blood glucose levels and variation can be attributed to various factors [8]. Pain, depth of anesthesia, surgical duration, and drugs that alter blood sugar homeostasis are a few of them.…”

“…The data are from a single tertiary care institute and include only patients with ASA physical statuses I and II. In contrast, candidates with a higher ASA physical status risk higher glycemic variability [8]. Although we standardized the depth of anesthesia, we did not keep the continuous data to compare them.…”

Impact of Different Crystalloids on the Blood Glucose Levels of Nondiabetic Patients Undergoing Major Elective Surgeries

“…The majority of nondiabetic individuals undergoing moderate- to high-risk surgery experienced intraoperative hyperglycemia. Therefore, the risk factors for intraoperative hyperglycemia must be determined [ 12 ].…”

Index of consciousness monitoring during general anesthesia may effectively enhance rehabilitation in elderly patients undergoing laparoscopic urological surgery: a randomized controlled clinical trial

“…IR is characterized by transient and reversible hyperglycemia, a condition also known as stressful hyperglycemia [40,41]. Recent studies [42,43] have shown that the incidence of postoperative hyperglycemia ranges from 20-40% in patients undergoing non-cardiac surgery. The presence of stress hyperglycemia is often accompanied by perioperative morbidity and mortality, a higher risk of postoperative wound infection, and a longer length of hospital stay.…”