Prospective Study of Postoperative Glycemic Control with a Standardized Insulin Infusion Protocol after Infrainguinal Bypass and Open Abdominal Aortic Aneurysm Repair

Steely, Andrea M.; Smith, Lisa; Callas, Peter W.; Nathan, Muriel H.; Lahiri, Julie E.; Stanley, Andrew; Steinthorsson, Georg; Bertges, Daniel J.

doi:10.1016/j.avsg.2017.04.020

Cited by 10 publications

(5 citation statements)

References 25 publications

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“…It has been recently shown prospectively in a single center series that for open AAA, a postoperative insulin protocol posed low risk to patients and was associated with reduced length of stay. (23) In this analysis, patients undergoing an open AAA repair had higher infection rates compared to patients undergoing EVAR (15.2% vs. 5.8%, p=.0002). In our analysis, factors associated with developing an infection were open AAA repair, postoperative hyperglycemia, renal failure, respiratory complications, myocardial infarction, posthemorrhagic anemia, and use of postoperative steroids or insulin administration.…”

Section: Discussionmentioning

confidence: 69%

“…This study concluded that postoperative hyperglycemia is common after bypass and AAA repair and can be effectively managed with an insulin infusion protocol. (23) The protocol was found to be low risk and was associated with reduced LOS and cost. The current analysis did not look at the introduction of an insulin protocol, but did find that the administration of insulin in the postoperative period was associated with infectious complications and mortality.…”

Section: Discussionmentioning

confidence: 97%

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Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair

Tarbunou

Smith

Kruse

et al. 2019

Journal of Vascular Surgery

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Among patients undergoing elective AAA repair, approximately one in six had postoperative hyperglycemia. After AAA repair in patients with and without diabetes, postoperative hyperglycemia was associated with adverse events, including in-hospital mortality and infections. Compared with those who had open surgery, patients undergoing endovascular repair who had postoperative hyperglycemia had greater risk of infection and death. After controlling for insulin administration and postoperative hyperglycemia, a diabetes diagnosis was associated with lower odds of both infection and in-hospital mortality. Our study suggests that hyperglycemia may be used as a clinical marker as it was found to be significantly associated with inferior outcomes after elective AAA repair. This retrospective study, however, cannot imply causation; further study using prospective methods is needed to elucidate the relationship between postoperative hyperglycemia and patient outcomes.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 97%

Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair

Tarbunou

Smith

Kruse

et al. 2019

Journal of Vascular Surgery

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“…• No difference in surgical site infection, cardiac, and pulmonary events in optimal versus suboptimal glucose control (p = 1.0). Length of stay was lower in optimal control group (4.2 vs. 7.3 days, p = 0.02) [53].…”

mentioning

confidence: 82%

Inpatient Glycemic Management of Non-cardiac CVD: Focus on Stroke and PVD

Everett

Mathioudakis

2018

Curr Diab Rep

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Hyperglycemia in acute stroke is associated with poor short and long-term outcomes, and perioperative hyperglycemia in those undergoing revascularization for PVD is linked to increased post-surgical complications. Studies evaluating tight glucose control do not demonstrate improvement in clinical outcomes, although the risk for hypoglycemia increases substantially. Additional studies are needed to evaluate tight glucose goals relative to our current standard of care and the role of permissive hyperglycemia. Given the limited data to guide glycemic management in these patient populations, it is recommended that general guidelines for inpatient glycemic control be followed. Special considerations should be made to address factors that may impact glucose management, including neurological deficits and clinical changes that occur in the postoperative state.

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“…Evidence-based glucose management strategies have demonstrated improved glycemic control, reduced length of stay, and reduced incidence of hypoglycemia. 17,18 Observational studies have found that maintaining blood glucose in-target is associated with lower 30-day readmission rates and shorter length of stay in medical and surgical patients. 19 In gynecologic oncology patients, pre-and post-intervention studies have shown that perioperative glycemic management pathways that are multidisciplinary, comprehensive, and adhere to best practices for glycemic management reduce the incidence of surgical site infections.…”

Section: Postoperative Hyperglycemia Is a Modifiable Risk Factor For Worse Postoperative Outcomesmentioning

confidence: 99%

Perioperative Glycemic Management for Patients with and without Diabetes

Ruzycki

Harrison

Cameron

et al. 2021

Can Journ Gen Int Med

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People with diabetes are at an increased risk for worse postoperative outcomes, compared to people without diabetes. Notably, up to one in 10 people who undergo surgery have unrecognized diabetes and an additional 10% may have postoperative hyperglycemia without meeting the criteria for a diagnosis of diabetes. Management of postoperative hyperglycemia has been demonstrated to reduce the incidence of poor outcomes, but evidence demonstrates that postoperative hyperglycemia remains a quality gap for surgical patients. In this review, we will outline the evidence for preoperative screening for postoperative hyperglycemic risk, review the evidence for perioperative glycemic management, and examine the barriers to these best practices. RÉSUMÉLes personnes atteintes de diabète courent un risque accru de voir leurs résultats postopératoires moins bons que ceux des personne non atteinte de diabète. En particulier, près d’une personne sur dix qui subit une intervention chirurgicale présente un diabète non diagnostiqué et dix pour cent supplémentaires peuvent présenter une hyperglycémie postopératoire sans pour autant répondre aux critères de diagnostic du diabète. Il a été démontré que le traitement de l’hyperglycémie postopératoire réduit l’incidence des mauvais résultats, mais les données probantes montrent que l’hyperglycémie postopératoire demeure une lacune chez les patients opérés. Dans cette revue, nous présentons les données probantes relatives au dépistage préopératoire du risque d’hyperglycémie postopératoire, nous passons en revue les données probantes relatives à la gestion de la glycémie périopératoire et nous examinons les obstacles à ces meilleures pratiques.

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Prospective Study of Postoperative Glycemic Control with a Standardized Insulin Infusion Protocol after Infrainguinal Bypass and Open Abdominal Aortic Aneurysm Repair

Cited by 10 publications

References 25 publications

Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair

Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair

Inpatient Glycemic Management of Non-cardiac CVD: Focus on Stroke and PVD

Perioperative Glycemic Management for Patients with and without Diabetes

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