The impact of hyperglycemia and obesity on hospitalization costs and clinical outcome in general surgery patients

Buehler, Lauren; Fayfman, Maya; Alexopoulos, Anastasia‐Stefania; Zhao, Liping; Farrokhi, Farnoosh; Weaver, Jeff; Smiley-Byrd, Dawn; Pasquel, Francisco J.; Vellanki, Priyathama; Umpiérrez, Guillermo E.

doi:10.1016/j.jdiacomp.2015.07.027

Cited by 51 publications

(26 citation statements)

References 43 publications

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“…[1][2][3][4][5][6][7] Hyperglycemia has been associated with infectious complications, the need for reoperative interventions, anastomotic failure, increased length of stay (LOS), increased readmission, and even increased mortality. 1,8,9 As well, in-hospital hyperglycemia is a common finding and may represent an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes.…”

mentioning

confidence: 99%

The association of postoperative glycemic control and lower extremity procedure outcomes

Vogel

Smith

Kruse

2017

Journal of Vascular Surgery

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One in five patients undergoing vascular procedures had postoperative hyperglycemia. Postoperative hyperglycemia was associated with adverse events after lower extremity vascular procedures in patients with and without diabetes, including infection, increased hospital utilization, and mortality. No difference was found with respect to hospital readmission. Postprocedure glucose management may represent an important quality marker for improving outcomes after lower extremity vascular procedures.

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mentioning

confidence: 99%

The association of postoperative glycemic control and lower extremity procedure outcomes

Vogel

Smith

Kruse

2017

Journal of Vascular Surgery

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“…Prior to conducting surgery on patients with DM2, preoperative assessment and planning is required to establish a suitable treatment regimen that will minimize the risk of complications [50,51]. Previous studies, in addition to our data, have shown that the period following a surgical procedure is often characterized by hyperglycemia, which results in a greater incidence of complications and higher costs connected to hospitalization [52][53][54].…”

Section: Discussionmentioning

confidence: 77%

Continuous Glucose Monitoring in Bariatric Patients Undergoing Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-En-Y Gastric Bypass

et al. 2019

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Background Few investigations have been conducted that compared blood glucose in patients with diabetes mellitus (DM2) and morbid obesity who had undergone laparoscopic sleeve gastrectomy (LSG) or gastric bypass (LRYGB). We aimed to compare the effects of these procedures using continuous glucose monitoring (CGM). Methods We prospectively studied patients that had qualified for LSG or LRYGB. The inclusion criteria were DM2 of ≤ 5 years, for which patients were taking oral anti-diabetic drugs, or no glucose metabolism disorder; and morbid obesity. CGM was performed between admission and the 10th postoperative day. Results We studied 16 patients with DM2 and 16 without. Eighteen patients underwent LSG and 14 underwent LRYGB. The median hemoglobin A1c was 5.5% (5.4-5.9%) in DM2 patients, which did not differ from control (p = 0.460). Preoperative mean daily glucose concentration was similar between DM2 and control patients (p = 0.622). For patients with DM2, LRYGB was associated with more frequent low glucose status, and these episodes lasted longer than in DM2 patients that underwent LSG (p = 0.035 and 0.049, respectively). DM2 patients that underwent LRYGB demonstrated lower glucose concentrations from third postoperative day than those that underwent LSG. Patients without DM2 did not demonstrate differences in daily mean glucose concentrations, or in incidence nor duration of hypoglycemia throughout the observation period.Conclusion A significantly larger reduction in interstitial glucose concentration is present from third day in patients with DM2 who undergo LRYGB vs. LSG, accompanied by a lower incidence and shorter duration of low glucose episodes.

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“…Robust literature from recent decades has repeatedly linked perioperative hyperglycemia to increased rates of complications and hospital mortality [55][56][57][58]. Conversely, studies in critically ill patients [59], cardiac surgery [60][61], and noncardiac surgery [56][57][58][62][63][64][65][66][67] have demonstrated that improved glycemic control mitigates the risk of developing multiorgan failure, curtails systemic as well as wound infections, and reduces short-and long-term mortality.…”

Section: Perioperative Implicationsmentioning

confidence: 99%

Perioperative insulin therapy

et al. 2017

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Surgical patients commonly develop hyperglycemia secondary to the neuroendocrine stress response. Insulin treatment of hyperglycemia is required to overcome the perioperative catabolic state and acute insulin resistance. Besides its metabolic actions on glucose metabolism, insulin also displays nonmetabolic physiological effects. Preoperative glycemic assessment, maintenance of normoglycemia, and avoidance of glucose variability are paramount to optimize surgical outcomes. This review discusses the basic physiology and effects of insulin as well as practical issues pertaining to its management during the perioperative period.

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The impact of hyperglycemia and obesity on hospitalization costs and clinical outcome in general surgery patients

Cited by 51 publications

References 43 publications

The association of postoperative glycemic control and lower extremity procedure outcomes

The association of postoperative glycemic control and lower extremity procedure outcomes

Continuous Glucose Monitoring in Bariatric Patients Undergoing Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-En-Y Gastric Bypass

Perioperative insulin therapy

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