Bath Jonathan, Kruse Robin L, Smith Jamie B, Balasundaram Naveen, Vogel Todd R
Division of Vascular Surgery, University of Missouri, Columbia, MO, USA.
Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA.
Vascular. 2020 Feb;28(1):16-24. doi: 10.1177/1708538119866528. Epub 2019 Jul 25.
: There are limited data evaluating the impact of postoperative hyperglycemia in patients undergoing vascular procedures. This study evaluated the relationship between suboptimal glucose control and adverse outcomes after carotid artery stenting (CAS) and carotid endarterectomy (CEA).
: Patients admitted for elective carotid procedures were selected from the Cerner Health Facts® (2008–2015) database using ICD-9-CM diagnosis and procedure codes. We examined the relationship between patient characteristics, postoperative hyperglycemia (any value >180 mg/dL), and complications with chi-square analysis. A multivariable model examined the association between patient characteristics, procedure type, and glucose control with infection, renal failure, stroke, respiratory and cardiac complications, and length of stay (LOS) over 10 days.
: Of the 4,287 patients admitted for an asymptomatic carotid procedure, 788 (18%) underwent CAS and 3,499 (82%) underwent CEA. Most patients (87%) had optimal postoperative glucose control (80–180 mg/dL); 13% had suboptimal glucose control. On average, patients with suboptimal glucose control experienced: higher stroke rates (6.2% vs. 2.7%; p < 0.001); more cardiac complications (5.1% vs. 2.0%; p < 0.001); longer hospital stays (3.1vs.1.8 days; p< .001); higher rates of post-procedure infection (4.0% vs.1.8%; p=.001); and more complications than patients with optimal glucose control. Multivariable logistic regression demonstrated that patients with suboptimal glucose control had higher odds of having an infectious (pneumonia, cellulitis, surgical site etc.) complication (OR 1.91, 95% CI 1.10–3.34), renal failure (OR 3.36, 95% CI 1.95–5.78), respiratory complications (OR 1.81, 95% CI 1.21–2.71), stroke (OR 1.82, 95% CI 1.15–2.88), or LOS>10 days (OR 4.07, 95% CI 2.02–8.20).
: Suboptimal glucose control was associated with adverse events after CAS and CEA, independent of a diabetes diagnosis. Several adverse outcomes were associated with hyperglycemia, including stroke. Given the singular role of carotid procedures in preventing stroke, we suggest that incorporating rigorous post-operative glucose control into best medical treatment of carotid disease should be considered as standard practice.
评估血管手术患者术后高血糖影响的数据有限。本研究评估了颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）后血糖控制不佳与不良结局之间的关系。
使用ICD-9-CM诊断和手术编码，从Cerner Health Facts®（2008 - 2015）数据库中选取接受择期颈动脉手术的患者。我们通过卡方分析研究了患者特征、术后高血糖（任何值>180 mg/dL）和并发症之间的关系。多变量模型研究了患者特征、手术类型和血糖控制与感染、肾衰竭、中风、呼吸和心脏并发症以及超过10天的住院时间（LOS）之间的关联。
在4287例因无症状颈动脉手术入院的患者中，788例（18%）接受了CAS，3499例（82%）接受了CEA。大多数患者（87%）术后血糖控制良好（80 - 180 mg/dL）；13%的患者血糖控制不佳。平均而言，血糖控制不佳的患者经历了：更高的中风发生率（6.2%对2.7%；p < 0.001）；更多的心脏并发症（5.1%对2.0%；p < 0.001）；更长的住院时间（3.1天对1.8天；p < 0.001）；更高的术后感染率（4.0%对1.8%；p = 0.001）；以及比血糖控制良好的患者更多的并发症。多变量逻辑回归表明，血糖控制不佳的患者发生感染（肺炎、蜂窝织炎、手术部位等）并发症（OR 1.91，95% CI 1.
