Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery

Juul, Anne Benedicte; Wetterslev, Jørn; Kofoed‐Enevoldsen, Allan

doi:10.1097/00003643-200407000-00004

Cited by 22 publications

(26 citation statements)

References 39 publications

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“…In our study, we confirmed the predictive value of many previously described risk factors for intermediateterm mortality after noncardiac surgery. Male sex, 15 history of stroke, 2 diabetes mellitus, 16 higher categories within the ASA Physical Status Classification System, 17 surgery for preexisting malignancy status, 15 and length of intensive care unit stay 18 were all significant predictors of intermediate-term mortality.…”

mentioning

confidence: 99%

Bispectral Index Monitoring, Duration of Bispectral Index Below 45, Patient Risk Factors, and Intermediate-term Mortality after Noncardiac Surgery in the B-Unaware Trial

Kertai

Palanca²,

Pal³

et al. 2011

Anesthesiology

129

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Background: Postoperative mortality has been associated with cumulative anesthetic duration below an arbitrary processed electroencephalographic threshold (bispectral index [BIS] Ͻ45). This substudy of the B-Unaware Trial tested whether cumulative duration of BIS values lower than 45, cumulative anesthetic dose, comorbidities, or intraoperative events were independently associated with postoperative mortality. Methods: The authors studied 1,473 patients (mean Ϯ SD age, 57.9 Ϯ 14.4 yr; 749 men) who underwent noncardiac surgery at Barnes-Jewish Hospital in St. Louis, Missouri. Multivariable Cox regression analysis was used to determine whether perioperative factors were independently associated with all-cause mortality. Results: A total of 358 patients (24.3%) died during a follow-up of 3.2 Ϯ 1.1 yr. There were statistically significant associations among various perioperative risk factors, including malignancy and intermediate-term mortality. BIS-monitored patients did not have lower mortality than unmonitored patients (24.9 vs. 23.7%; difference ϭ 1.2%, 95% CI, Ϫ3.3 to 5.6%). Cumulative duration of BIS values less than 45 was not associated with mortality (multivariable hazard

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mentioning

confidence: 99%

Bispectral Index Monitoring, Duration of Bispectral Index Below 45, Patient Risk Factors, and Intermediate-term Mortality after Noncardiac Surgery in the B-Unaware Trial

Kertai

Palanca²,

Pal³

et al. 2011

Anesthesiology

129

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show abstract

“…All diabetes patients, even if dietcontrolled, should have a preoperative fasting glucose, and when glucose concentration exceeds 180 mg/dl, clinicians should initiate insulin therapy. 6,8,11 A hemoglobin A1c that is <7% is often associated with evidence of good long-term glucose control and has also been demonstrated to decrease the rate of infectious complications across a variety of surgical procedures. 20 Hemoglobin A1c levels ≥7% may indicate poor control, and elevated BG levels in those patients may require slower reduction in BG with more vigilant monitoring.…”

Section: Preoperative Blood Glucose Effects On Intraoperative Carementioning

confidence: 99%

“…Predictors of death were ischemic heart disease, urgent surgery, American Society of Anesthesiologists physical status score, and hyperglycemia. 7,8 A high blood glucose (BG) level is one component of anesthetic care that may need more stringent control, as evidenced by many studies, but tight control may also have negative outcomes as shown in the data from the Normoglycemia in Intensive Care EvaluationSurvival Using Glucose Algorithm Regulation (NICE-SUGAR) study. 9 NICE-SUGAR is a large multicenter study published in April 2009, which included 6104 intensive care unit (ICU) patients in three different countries.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Blood Glucose Monitoring in the General Surgical Population

Raju

Torjman

Goldberg

2009

J Diabetes Sci Technol

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Several studies have shown a relationship between poor outcome and uncontrolled blood glucose (BG) in cardiac, neurosurgical, critical care, and general surgical patients. A major study showed that tight glycemic control (80–110mg/dl) was related to increased mortality. Based on evidence from controlled studies, the American Diabetes Association, and the Society of Thoracic Surgeons, maintaining intraoperative BG levels in the 140–180 mg/dl range seems appropriate. Optimization of the patient's preoperative medications and the use of insulin infusions, as well as surgical and anesthetic technique, are important factors for achieving desirable perioperative BG control. Minimizing BG variability during surgery should be part of the glycemic control strategy. Advances in real-time glucose monitoring may soon benefit hospitalized diabetes and nondiabetes patients.

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“…Often, these patients undergo general anesthesia for a variety of surgical procedures, and rates of perioperative complications are known to be higher in patients with longstanding diabetes than nondiabetic patients (Lee et al, 1999;Hoeks et al, 2009). For example, the postoperative mortality of diabetic patients after both cardiac and noncardiac surgery is significantly higher than that of nondiabetic patients (Thourani et al, 1999;Axelrod et al, 2002;Juul et al, 2004;Ganesh et al, 2005), and the long-term outcome in diabetic patients after noncardiac surgery is frequently associated with stroke and early death (Halm et al, 2009). Often, the increased postoperative mortality is the result of cardiovascular complications (Juul et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…For example, the postoperative mortality of diabetic patients after both cardiac and noncardiac surgery is significantly higher than that of nondiabetic patients (Thourani et al, 1999;Axelrod et al, 2002;Juul et al, 2004;Ganesh et al, 2005), and the long-term outcome in diabetic patients after noncardiac surgery is frequently associated with stroke and early death (Halm et al, 2009). Often, the increased postoperative mortality is the result of cardiovascular complications (Juul et al, 2004). This fact is not surprising given that diabetic patients have a higher prevalence of cardiovascular comorbidities (Booth et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Effect of Isoflurane on Myocardial Energetic and Oxidative Stress in Cardiac Muscle from Zucker Diabetic Fatty Rat

Shen

Bhatt²,

et al. 2014

J Pharmacol Exp Ther

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The effect of inhalational anesthetics on myocardial contraction and energetics in type 2 diabetes mellitus is unknown. We investigated the effect of isoflurane (ISO) on force and intracellular Ca 21 transient (iCa), myocardial oxygen consumption (MVO 2 ), and energetics/redox behavior in trabecular muscles from Zucker diabetic fatty (ZDF) rats. At baseline, force and corresponding iCa were lower in ZDF trabeculae than in controls. ISO decreased force in both groups in a dosedependent manner. ISO did not affect iCa amplitude in controls, but ISO . 1.5% significantly reduced iCa amplitude in ZDF trabeculae. ISO-induced force depression fully recovered as a result of increased iCa when external Ca 21 was raised in controls. However, both force and iCa remained low in ZDF muscle at elevated external Ca 21 . In controls, force, iCa, and MVO 2 increased when stimulation frequency was increased from 0.5 to 1.5 Hz. ZDF muscles, however, exhibited blunted responses in force and iCa and decreased MVO 2 . Oxidative stress levels were unchanged in control muscles but increased significantly in ZDF muscles after exposure to ISO. Finally, the depressive effect of ISO was prevented by 4-hydroxy-2,2,6,6-tetramethylpiperidine-N-oxyl (Tempol) in ZDF muscles. These findings suggest that ISO dose-dependently attenuates force in control and ZDF muscles with differential effect on iCa. The mechanism of force depression by ISO in controls is mainly decreased myofilament Ca 21 sensitivity, whereas in ZDF muscles the ISO-induced decrease in contraction is due to worsening oxidative stress, which inhibits iCa and force development.

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Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery

Cited by 22 publications

References 39 publications

Bispectral Index Monitoring, Duration of Bispectral Index Below 45, Patient Risk Factors, and Intermediate-term Mortality after Noncardiac Surgery in the B-Unaware Trial

Bispectral Index Monitoring, Duration of Bispectral Index Below 45, Patient Risk Factors, and Intermediate-term Mortality after Noncardiac Surgery in the B-Unaware Trial

Perioperative Blood Glucose Monitoring in the General Surgical Population

Effect of Isoflurane on Myocardial Energetic and Oxidative Stress in Cardiac Muscle from Zucker Diabetic Fatty Rat

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