Intraoperative Hyperglycemia and Perioperative Outcomes in Cardiac Surgery Patients

Gandhi, Gunjan Y.; Nuttall, Gregory A.; Abel, Martin; Mullany, Charles J.; Schaff, Hartzell V.; Williams, Brent A.; Schrader, Lisa M.; Rizza, Robert A.; McMahon, M. Molly

doi:10.4065/80.7.862

Cited by 435 publications

(254 citation statements)

References 14 publications

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“…5,27,28 However, there is no unified definition of perioperative ''hyperglycemia'' at present, and how tight the glucose control should be is still a controversial problem. Although the study by van den Berghe et al 5 provided strong evidence for the benefits of IIT, the results could not be extrapolated to patients who were not in the surgical ICU.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Cai

et al. 2013

Diabetes Technology & Therapeutics

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Background: Hyperglycemia is common and hard to control in surgical patients with diabetes. We retrospectively investigated short-term effects of continuous subcutaneous insulin infusion (CSII) in perioperative patients with diabetes. Patients and Methods: Perioperative patients with diabetes discharged between January 1, 2006 and January 1, 2012 were included. Glucose control and postoperative outcomes were compared between the patients using CSII or non-CSII insulin therapy. Results: We identified 108 pairs of patients matched by propensity and surgical category who were using CSII therapy (CSII group) or non-CSII insulin therapy (control group). The CSII group had significantly lower fasting glucose levels (on the first postoperative day, 9.06 -3.09 mmol/L vs. 11.05 -4.19 mmol/L; P = 0.003) and lower mean glucose levels (on the operation day, 9.93 -2.65 mmol/L vs. 12.05 -3.86 mmol/L; P = 0.001). The CSII group also had a lower incidence of fever (on the first postoperative day, 30.4% vs. 53.2%; P = 0.005). Furthermore, patients in the CSII group experienced significantly shorter postoperative intervals for suture removal (P = 0.02) and hospital discharge (P = 0.03). No significant difference in the total medical expenditure was observed between the two groups (P = 0.47). We also made a comparison between the 30 pairs of patients who were using CSII or multiple daily insulin injection therapy but observed no significant difference between these two therapies in glucose control or postoperative outcomes. Conclusions: Compared with non-CSII insulin therapy, even short-term implementation of CSII can improve the postoperative control of glucose, reduce the incidence of postoperative fever, and shorten the time for suture removal and discharge in surgical patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Cai

et al. 2013

Diabetes Technology & Therapeutics

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“…[33][34][35][36][37] In critically ill patients, mortality is positively correlated with increasing glucose levels [ 5 mmolÁL -1 , 38 and in patients undergoing cardiovascular procedures, hyperglycemia was associated with increased mortality and organ dysfunction. 39 Patients with fasting glucose levels [ 7 mmolÁL -1 or random blood glucose levels [ 11.1 mmolÁL -1 on general surgical wards had an 18-fold increase in in-hospital mortality, a longer stay, and a greater risk of infection. 33 Acute changes in glucose levels may facilitate the development of post-traumatic chronic pain.…”

Section: Glucose Metabolismmentioning

confidence: 99%

Perioperative catabolism

Schricker

Lattermann

2015

Can J Anesth/J Can Anesth

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“…While this difference may seem insignificant, data suggest that increases in glucose as small as 1.11 mmolÁL -1 among cardiac surgery patients are associated with a 34% increase in the likelihood of a perioperative complication, such as infection, delirium, need for mechanical ventilation, or death. 6 While preoperative glucose is clearly the stronger predictor of postoperative control, HbA 1c has the advantage of being available before the day of surgery. Duration of surgery has been associated with postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…4 Several studies show that perioperative hyperglycemia is associated with morbidity. 5,6 An association between baseline glucose regulation and hyperglycemia in critically ill patients has been reported. 7 In trauma patients, there is a relationship between HbA 1c and hyperglycemia after a stress response.…”

Section: Résumémentioning

confidence: 99%

The relationship between glycosylated hemoglobin and perioperative glucose control in patients with diabetes

Moitra

Greenberg

Arunajadai

et al. 2010

Can J Anesth/J Can Anesth

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Intraoperative Hyperglycemia and Perioperative Outcomes in Cardiac Surgery Patients

Cited by 435 publications

References 14 publications

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Perioperative catabolism

The relationship between glycosylated hemoglobin and perioperative glucose control in patients with diabetes

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