Preoperative hyperglycemia is associated with elevated risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery: A retrospective cohort study

Abstract

BackgroundDiabetes mellitus (DM) has been reported to be associated with perioperative stroke, but the effects of preoperative hyperglycemia on the risk of perioperative stroke in diabetic patients undergoing non-cardiovascular surgery remain unclear. This study investigated the association between preoperative hyperglycemia and the risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery.MethodsThis retrospective cohort study screened 27,002 patients with type 2 DM undergoing non-cardiovascular surgery with general anesthesia between January 2008 and August 2019 at The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital. The exposure of interest was preoperative hyperglycemia, defined as a fasting plasma glucose (FPG) ≥ 7 mmol/L. The outcome of interest was a new diagnosis of perioperative ischemic stroke within 30 days after surgery. Residual confounding was minimized by controlling for observable patient and intraoperative factors. Logistic regression was conducted in the total and propensity score matched cohorts. In addition, we stratified patients into six subgroups to investigate whether the association between preoperative hyperglycemia and perioperative ischemic stroke differs in these subgroups.ResultsThe overall incidence of perioperative ischemic stroke was 0.53% (n = 144) in the current cohort. The odds of perioperative ischemic stroke were significantly increased for patients with preoperative hyperglycemia after adjusting for patient- related variables (OR: 1.95; 95% CI: 1.39–2.75; p < 0.001), surgery-related variables (OR: 2.1; 95% CI: 1.51–2.94; p < 0.001), and all confounding variables (OR: 1.78; 95% CI: 1.26–2.53; p < 0.001). The risk of perioperative stroke was significantly increased in patients with preoperative hyperglycemia (OR: 2.51; 95% CI: 1.66–3.9; p < 0.001) in the propensity score matched cohort. Preoperative hyperglycemia was associated with the outcome for all the subgroups except for patients undergoing neurosurgery.ConclusionPreoperative hyperglycemia is associated with an elevated risk of perioperative stroke in patients with type 2 DM undergoing non-cardiovascular surgery. The effect could be eliminated for patients undergoing neurosurgery, during which specific risk factors should be considered.

Preoperative fasting glucose value can predict acute kidney injury in non-cardiac surgical patients without diabetes but not in patients with diabetes

“…Till now, no consensus on the controlled target of preoperative or perioperative glucose level has been reached, some guidelines recommend perioperative glucose value below 10 mmol/L or between 6 and 10 mmol/L to avoid hyperglycemia or hypoglycemia (Dhatariya et al 2012 ; Cosson et al 2018 ; Association of Anaesthetists of Great Britain and Ireland 2015 ), but the European Society of Anesthesiology guideline recommend no routine preoperative glucose assessment for non-cardiac surgery (Hert et al 2018 ). Many studies reported the threshold values of preoperative glucose for a specific complication after surgery, which showed that the preoperative fasting glucose level of 5.135 mmol/L is the cut-off value to predict mortality within 30 days after neurosurgery (Zhang et al 2023 ), and the level greater than 7 mmol/L can predict the development of stroke within 30 days after non-cardiac surgery (Liu et al 2022 ); in another retrospective study, the preoperative casual blood glucose value of 6.86 mmol/L in non-diabetic patients and 7.92 mmol/L in diabetic patients could predict postoperative myocardial injury in non-cardiac surgery (Punthakee et al 2018 ). In our study, the cut-off value of preoperative fasting glucose was 5.39 mmol/L to predict AKI in non-cardiac surgery.…”

Incidence and risk factors of peri‐operative stroke in major non‐cardiovascular, non‐neurologic surgery—A retrospective register‐based cohort study

“…In a 2011 study of 529,059 patients undergoing non‐cardiac, non‐neurosurgical procedures, age >61 years was identified as the strongest independent risk factor for peri‐operative stroke, followed by myocardial infarction within 6 months, acute renal failure or pre‐existing dialysis, prior stroke/transient ischaemic attack, hypertension, chronic obstructive pulmonary disease and smoking 3 . Other studies have supported these findings, 2,5–8 as well as identifying diabetes mellitus and hyperglycaemia, 7,9 current or prior atrial fibrillation, 7,10,11 congestive heart failure, 2,7 valvular heart disease, 7 renal disease, 7 coronary artery disease, 12 cancer, patent foramen ovale 4,13 and migraine 14 as independent risk factors for peri‐operative stroke 2,7,8,13 . Additionally, the impact of pre‐existing medications, such as statins 15 and acetylsalicylic acid, 16,17 has also been studied in relation to peri‐operative stroke with generally inconclusive results, along with ramifications of intra‐operative management strategies, none of which clearly demonstrates superiority.…”