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Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program.

Publication ,  Journal Article
Kwon, S; Thompson, R; Dellinger, P; Yanez, D; Farrohki, E; Flum, D
Published in: Ann Surg
January 2013

OBJECTIVE: To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations. BACKGROUND: There is limited evidence to characterize the impact of perioperative hyperglycemia and insulin on adverse outcomes in patients, with and without diabetes, undergoing general surgical procedures. METHODS: The Surgical Care and Outcomes Assessment Program is a Washington State quality improvement benchmarking-based initiative. We evaluated the relationship of perioperative hyperglycemia (>180 mg/dL) and insulin administration on mortality, reoperative interventions, and infections for patients undergoing elective colorectal and bariatric surgery at 47 participating hospitals between fourth quarter of 2005 and fourth quarter of 2010. RESULTS: Of the 11,633 patients (55.4 ± 15.3 years; 65.7% women) with a serum glucose determination on the day of surgery, postoperative day 1, or postoperative day 2, 29.1% of patients were hyperglycemic. After controlling for clinical factors, those with hyperglycemia had a significantly increased risk of infection [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.63-2.44], reoperative interventions (OR, 1.8; 95% CI, 1.41-2.3), and death (OR, 2.71; 95% CI, 1.72-4.28). Increased risk of poor outcomes was observed both for patients with and without diabetes. Those with hyperglycemia on the day of surgery who received insulin had no significant increase in infections (OR, 1.01; 95% CI, 0.72-1.42), reoperative interventions (OR, 1.29; 95% CI, 0.89-1.89), or deaths (OR, 1.21; 95% CI, 0.61-2.42). A dose-effect relationship was found between the effectiveness of insulin-related glucose control (worst 180-250 mg/dL, best <130 mg/dL) and adverse outcomes. CONCLUSIONS: Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than those with normal blood glucoses. Perioperative glucose evaluation and insulin administration in patients with hyperglycemia are important quality targets.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

January 2013

Volume

257

Issue

1

Start / End Page

8 / 14

Location

United States

Related Subject Headings

  • Washington
  • Surgical Wound Infection
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Rectum
  • Perioperative Care
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
 

Citation

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Chicago
ICMJE
MLA
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Kwon, S., Thompson, R., Dellinger, P., Yanez, D., Farrohki, E., & Flum, D. (2013). Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg, 257(1), 8–14. https://doi.org/10.1097/SLA.0b013e31827b6bbc
Kwon, Steve, Rachel Thompson, Patchen Dellinger, David Yanez, Ellen Farrohki, and David Flum. “Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program.Ann Surg 257, no. 1 (January 2013): 8–14. https://doi.org/10.1097/SLA.0b013e31827b6bbc.
Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013 Jan;257(1):8–14.
Kwon, Steve, et al. “Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program.Ann Surg, vol. 257, no. 1, Jan. 2013, pp. 8–14. Pubmed, doi:10.1097/SLA.0b013e31827b6bbc.
Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013 Jan;257(1):8–14.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

January 2013

Volume

257

Issue

1

Start / End Page

8 / 14

Location

United States

Related Subject Headings

  • Washington
  • Surgical Wound Infection
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Rectum
  • Perioperative Care
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male