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Cited by 441Hyperglycemia and glycemic control in critically ill and hospitalized patientsEnhanced Recovery After SurgeryCardiac, Anesthesia and Surgical Outcomes

Perioperative Hyperglycemia and Risk of Adverse Events Among Patients With and Without Diabetes

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Kotagal, Meera, Symons, Rebecca G., Hirsch, Irl B., Umpierrez, Guillermo E., Dellinger, E. Patchen, Farrokhi, Ellen T., Flum, David R.·2015·Annals of Surgery
DOI 10.1097/sla.0000000000000688PMC PMC4208939
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Abstract

OBJECTIVE: To study the association between diabetes status, perioperative hyperglycemia, and adverse events in a statewide surgical cohort. BACKGROUND: Perioperative hyperglycemia may increase the risk of adverse events more significantly in patients without diabetes (NDM) than in those with diabetes (DM). METHODS: Using data from the Surgical Care and Outcomes Assessment Program, a cohort study (2010-2012) evaluated diabetes status, perioperative hyperglycemia, and composite adverse events in abdominal, vascular, and spine surgery at 53 hospitals in Washington State. RESULTS: Among 40,836 patients (mean age, 54 years; 53.6% women), 19% had diabetes; 47% underwent a perioperative blood glucose (BG) test, and of those, 18% had BG ≥180 mg/dL. DM patients had a higher rate of adverse events (12% vs 9%, P < 0.001) than NDM patients. After adjustment, among NDM patients, those with hyperglycemia had an increased risk of adverse events compared with those with normal BG. Among NDM patients, there was a dose-response relationship between the level of BG and composite adverse events [odds ratio (OR), 1.3 for BG 125-180 (95% confidence interval (CI), 1.1-1.5); OR, 1.6 for BG ≥180 (95% CI, 1.3-2.1)]. Conversely, hyperglycemic DM patients did not have an increased risk of adverse events, including those with a BG 180 or more (OR, 0.8; 95% CI, 0.6-1.0). NDM patients were less likely to receive insulin at each BG level. CONCLUSIONS: For NDM patients, but not DM patients, the risk of adverse events was linked to hyperglycemia. Underlying this paradoxical effect may be the underuse of insulin, but also that hyperglycemia indicates higher levels of stress in NDM patients than in DM patients.

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Cited by

Sorted by citations

Authors
Kotagal, M., Symons, R. G., Hirsch, I. B., Umpierrez, G. E., Dellinger, E. P., Farrokhi, E. T., & Flum, D. R.
Affiliations
  • Emory University (US)
  • University of Washington (US)
  • Foundation for Health Care Quality (US)
Corresponding author
  • Kotagal, Meera
  • Flum, David R.
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-01
Volume
261
Issue
1
Pages
97-103
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/sla.0000000000000688
PMC
PMC4208939
OpenAlex
W2017693127
Cited by
441
References
1
Citations by year
2026: 32 · 2025: 37 · 2024: 46 · 2023: 45 · 2022: 51 · 2021: 50 · 2020: 48 · 2019: 36 · 2018: 29 · 2017: 29 · 2016: 24 · 2015: 13
FWCI
17.71
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (T32DK070555, P30DK017047)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords
perioperative hyperglycemia, diabetes mellitus, surgical adverse events, blood glucose, insulin use, abdominal surgery, vascular surgery, spinal surgery, dose-response relationship, stress response
MeSH terms
Abdomen, Female, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Postoperative Complications, Risk Factors, Spine, Vascular Surgical Procedures, Washington, Diabetes Complications, Bariatric Surgery, Perioperative Period

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