Post-operative hyperglycaemia in non-diabetic patients following elective gynaecological surgeries: incidence and risk factors
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262088Keywords:
Postoperative, Hyperglycemia, Elective gynecological surgery, Non-diabeticAbstract
Background: There is a dearth of information on the incidence, risk factors, and impact of postoperative hyperglycemia following Gynaecological surgeries. This study explores the incidence and predictors of postoperative hyperglycemia following elective Gynaecological surgeries and its association with postoperative outcomes.
Methods: The non-diabetic patients admitted for elective gynaecological surgeries who met inclusion criteria and were willing to participate were enrolled. Blood glucose was checked in the post-operative period at 2,6,12,24, and 48 hours, respectively. Hyperglycemia was defined as any blood glucose value of >126 mg/dl and clinically significant hyperglycemia as >180 mg/dl. All patients were followed up for 30 days. Outcome measures were the incidence of post-operative hyperglycemia and the relation of hyperglycemia with peri-operative parameters and infections.
Results: Out of the 200 patients, post-operative hyperglycaemia was observed in 61.5% of patients and 12.5% had severe hyperglycaemia. The mean BMI of patients with hyperglycaemia (25.8±3.8kg/m2) was significantly more than euglycemic ones (24.4±4.0kg/m2 (p=0.019)). Procedures lasting >2 hours were significantly associated with hyperglycemia (p=0.002) and its severity (p=0.006). Post-operative infectious complications and the need for therapeutic antibiotics were higher among hyperglycaemic patients (p=0.053).
Conclusions: Postoperative hyperglycemia in non-diabetic patients following elective gynaecologic surgeries is associated with an increased risk of infections. Postoperative monitoring of blood glucose should be done for all patients. If universal monitoring is not feasible, then patients with high BMI undergoing open abdominal surgeries lasting more than 2 hours should undergo vigilant post-operative monitoring for hyperglycemia.
References
Duncan E. Hyperglycemia and Perioperative Glucose Management. Curr Pharm Des. 2012;18(38):6195-203.
Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatcliffe C, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2011;33:1783-8.
Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005;130(4):1144-50.
McGirt MJ, Woodworth GF, Brooke BS, Coon AL, Jain S, Buck D, et al. Hyperglycemia independently increases the risk of perioperative stroke, myocardial infarction, and death after carotid endarterectomy. Neurosurgery. 2006;58:1066-73.
Ambiru S, Kato A, Kimura F, Shimizu H, Yoshidome H, Otsuka M, et al. Poor postoperative blood glucose control increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: a prospective study in a high-volume institute in Japan. J Hosp Infect. 2008;68:230-3.
McConnell YJ, Johnson PM, Porter GA. Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointest Surg. 2009;13:508-15.
Ata A, Lee J, Bestle SL, Desemone J, Stain SC. Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg. 2010;145:858-64.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-67.
Kotagal M, Symons RG, Hirsch IB, Umpierrez GE, Dellinger EP, Farrokhi ET, et al. SCOAP-CERTAIN Collaborative: Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg. 2015; 261:97-103.
Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978-82.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999;20(4):250-78.
Kiran RP, Turina M, Hammel J, Fazio V. The clinical significance of an elevated postoperative glucose value in non-diabetic patients after colorectal surgery: evidence for the need for tight glucose control?. Ann Surg. 2013;258:599-604.
Fiorillo C, Rosa F, Quero G, Menghi R, Doglietto GB, Alfieri S. Postoperative hyperglycemia in nondiabetic patients after gastric surgery for cancer: perioperative outcomes. Gastric Cancer 2017;20:536-42.
Gachabayov M, Senagore AJ, Abbas SK, Yelika SB, You K, Bergamaschi R. Perioperative hyperglycaemia: an unmet need within a surgical site infection bundle. Tech Coloproctol. 2018;22(3):201-7.
Offodile AC, Chou HY, Lin JA, Loh CYY, Chang KP, Aycart MA, et al. Hyperglycaemia and risk of adverse outcomes following microvascular reconstruction of oncologic head and neck defects. Oral Oncol. 2018;79:15-9.
Talbot TR. Diabetes mellitus and cardiothoracic surgical site infections. Am J Infect Control. 2005;33:353-9.
Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al., NICE-SUGAR Study Investigators, Intensive versus conventional glucose control in critically ill patients N. Engl J Med. 2009;360(13):1283-97.
Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109-17.
Esposito K, Nappo F, Marfella R, Giugliano G, Giugliano F, Ciotola M, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: Role of oxidative stress. Circulation. 2002;106:2067-72.
Rassias AJ, Marrin CA, Arruda J, Whalen PK, Beach M, Yeager MP. Insulin infusion improves neutrophil function in diabetic cardiac surgery patients. Anesth Analg. 1999;88(5):1011-6.