Perioperative Hyperglycemia Management

Duggan, Elizabeth W.; Carlson, Karen; Umpiérrez, Guillermo E.

doi:10.1097/aln.0000000000001515

Cited by 307 publications

(340 citation statements)

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“…Peri‐operative hyperglycaemia is all too common (incidence 20%‐40%) and is associated with significant surgical morbidity and mortality . Often defined as a blood glucose level >11.1 mmol/L, peri‐operative hyperglycaemia increases the risk of developing costly surgical site infections or sepsis, impairs wound healing, promotes endothelial dysfunction, thrombus formation, myocardial ischaemia, stroke and neurocognitive dysfunction, prolongs the length of hospitalization, and can even result in death .…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Often defined as a blood glucose level >11.1 mmol/L, peri‐operative hyperglycaemia increases the risk of developing costly surgical site infections or sepsis, impairs wound healing, promotes endothelial dysfunction, thrombus formation, myocardial ischaemia, stroke and neurocognitive dysfunction, prolongs the length of hospitalization, and can even result in death . These detrimental consequences appear to be dependent on both the severity of hyperglycaemia and the duration of poor glycaemic control . With current trends suggesting nearly 520 million people will have diabetes worldwide by 2030, it is likely the incidence of peri‐operative hyperglycaemia is also increasing .…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Numerous guidelines on the peri‐operative management of patients with diabetes and hyperglycaemia undergoing surgery, including those published by the American Diabetes Association, Australian Diabetes Society, Association of Anaesthetists of Great Britain and Ireland and Society for Ambulatory Surgery, suggest the peri‐operative continuation of metformin should be considered . It remains noteworthy that these are based largely on consensus opinion for the perceived benefits of continuing metformin because of the absence of any supportive clinical trial data.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…quences appear to be dependent on both the severity of hyperglycaemia and the duration of poor glycaemic control. 1 With current trends suggesting nearly 520 million people will have diabetes worldwide by 2030, it is likely the incidence of peri-operative hyperglycaemia is also increasing. 8 Effective strategies to manage and improve peri-operative glycaemic control, therefore, are urgently needed.…”

mentioning

confidence: 99%

“…Numerous guidelines on the peri-operative management of patients with diabetes and hyperglycaemia undergoing surgery, including those published by the American Diabetes Association, Australian Diabetes Society, Association of Anaesthetists of Great Britain and Ireland and Society for Ambulatory Surgery, suggest the perioperative continuation of metformin should be considered. 1,8,[10][11][12][13] It remains noteworthy that these are based largely on consensus opinion for the perceived benefits of continuing metformin because of the absence of any supportive clinical trial data. Previously, a retrospective study suggested that the unintended continuation of metformin until the time of cardiac surgery did not increase the risk of serious adverse events, but instead reduced rates of infection, shortened the duration of tracheal intubation, and reduced overall morbidity, suggesting overall benefit.…”

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confidence: 99%

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Metformin for the management of peri‐operative hyperglycaemia

Brown

Paul

2017

Diabetes Obesity Metabolism

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Section: Conflict Of Interestmentioning

confidence: 99%

Section: Conflict Of Interestmentioning

confidence: 99%

Section: Conflict Of Interestmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Metformin for the management of peri‐operative hyperglycaemia

Brown

Paul

2017

Diabetes Obesity Metabolism

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Association of Preoperative Medical Consultation With Reduction in Adverse Postoperative Outcomes and Use of Processes of Care Among Residents of Ontario, Canada

et al. 2023

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ImportanceIt is uncertain whether preoperative medical consultation reduces adverse postoperative clinical outcomes.ObjectiveTo investigate the association of preoperative medical consultation with reduction in adverse postoperative outcomes and use of processes of care.Design, Setting, and ParticipantsThis was a retrospective cohort study using linked administrative databases from an independent research institute housing routinely collected health data for Ontario’s 14 million residents, including sociodemographic features, physician characteristics and services, and receipt of inpatient and outpatient care. The study sample included Ontario residents aged 40 years or older who underwent their first qualifying intermediate- to high-risk noncardiac operation. Propensity score matching was used to adjust for differences between patients who did and did not undergo preoperative medical consultation with discharge dates between April 1, 2005, and March 31, 2018. The data were analyzed from December 20, 2021, to May 15, 2022.ExposuresReceipt of preoperative medical consultation in the 4 months preceding the index surgery.Main Outcomes and MeasuresThe primary outcome was 30-day all-cause postoperative mortality. Secondary outcomes included 1-year mortality, inpatient myocardial infarction and stroke, in-hospital mechanical ventilation, length of stay, and 30-day health system costs.ResultsOf the total 530 473 individuals (mean [SD] age, 67.1 [10.6] years; 278 903 [52.6%] female) included in the study, 186 299 (35.1%) received preoperative medical consultation. Propensity score matching resulted in 179 809 well-matched pairs (67.8% of the full cohort). The 30-day mortality rate was 0.9% (n = 1534) in the consultation group and 0.7% (n = 1299) in the control group (odds ratio [OR], 1.19; 95% CI, 1.11-1.29). The ORs for 1 year mortality (OR, 1.15; 95% CI, 1.11-1.19), inpatient stroke (OR, 1.21; 95% CI, 1.06-1.37), in-hospital mechanical ventilation (OR, 1.38; 95% CI, 1.31-1.45), and 30-day emergency department visits (OR, 1.07; 95% CI, 1.05-1.09) were higher in the consultation group; however, the rates of inpatient myocardial infarction did not differ. The lengths of stay in acute care were a mean (SD) 6.0 (9.3) days in the consultation group and 5.6 (10.0) days in the control group (difference, 0.4 [95% CI, 0.3-0.5] days), and the median (IQR) total 30-day health system cost was CAD $317 ($229-$959) (US $235 [$170-$711]) higher in the consultation group. Preoperative medical consultation was associated with increased use of preoperative echocardiography (OR, 2.64; 95% CI, 2.59-2.69) and cardiac stress tests (OR, 2.50; 95% CI, 2.43-2.56) and higher odds of receiving a new prescription for β-blockers (OR, 2.96; 95% CI, 2.82-3.12).Conclusions and RelevanceIn this cohort study, preoperative medical consultation was not associated with a reduction but rather with an increase in adverse postoperative outcomes, suggesting a need for further refinement of target populations, processes, and interventions related to preoperative medical consultation. These findings highlight the need for further research and suggest that referral for preoperative medical consultation and subsequent testing should be carefully guided by individual-level consideration of risks and benefits.

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