Oba Takeshi, Nagao Mototsugu, Kobayashi Shunsuke, Yamaguchi Yuji, Nagamine Tomoko, Tanimura-Inagaki Kyoko, Fukuda Izumi, Sugihara Hitoshi
Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Ther Adv Endocrinol Metab. 2022 May 19;13:20420188221099349. doi: 10.1177/20420188221099349. eCollection 2022.
Perioperative hyperglycemia is a risk factor for postoperative complications in the general population. However, it has not been clarified whether perioperative hyperglycemia increases postoperative complications in patients with type-2 diabetes mellitus (T2D). Therefore, we aimed to analyze the relationship between perioperative glycemic status and postoperative complications in non-intensive care unit (non-ICU) hospitalized patients with T2D.
Medical records of 1217 patients with T2D who were admitted to the non-ICU in our hospital were analyzed retrospectively. Relationships between clinical characteristics including perioperative glycemic status and postoperative complications were assessed using univariate and multivariate analyses. Perioperative glycemic status was evaluated by calculating the mean, standard deviation (SD), and coefficient of variation (CV) of blood glucose (BG) measurements in preoperative and postoperative periods for three contiguous days before and after surgery, respectively. Postoperative complications were defined as infections, delayed wound healing, postoperative bleeding, and/or thrombosis.
Postoperative complications occurred in 139 patients (11.4%). These patients showed a lower BG immediately before surgery ( = 0.04) and a higher mean postoperative BG ( = 0.009) than those without postoperative complications. There were no differences in the other perioperative BG parameters including BG variability and the frequency of hypoglycemia. The multivariate analysis showed that BG immediately before surgery (adjusted odds ratio (95% confidence interval [CI]), 0.91 (0.85-0.98), = 0.01) and mean postoperative BG (1.11 (1.05-1.18), < 0.001) were independently associated with postoperative complications.
Perioperative glycemic status, that is, a low BG immediately before surgery and a high mean postoperative BG, are associated with the increased incidence of postoperative complications in non-ICU patients with T2D.
围手术期高血糖是普通人群术后并发症的一个危险因素。然而，围手术期高血糖是否会增加2型糖尿病（T2D）患者的术后并发症尚未明确。因此，我们旨在分析非重症监护病房（非ICU）住院的T2D患者围手术期血糖状态与术后并发症之间的关系。
回顾性分析我院非ICU收治的1217例T2D患者的病历。使用单因素和多因素分析评估包括围手术期血糖状态在内的临床特征与术后并发症之间的关系。围手术期血糖状态分别通过计算手术前三天和手术后三天连续三天的术前和术后血糖（BG）测量值的平均值、标准差（SD）和变异系数（CV）来评估。术后并发症定义为感染、伤口愈合延迟、术后出血和/或血栓形成。
139例患者（11.4%）发生术后并发症。与无术后并发症的患者相比，这些患者术前即刻BG较低（=0.04），术后平均BG较高（=0.009）。在其他围手术期BG参数（包括BG变异性和低血糖频率）方面没有差异。多因素分析显示，术前即刻BG（调整后的比值比（95%置信区间[CI]），0.91（0.85 - 0.98），=0.01）和术后平均BG（1.11（1.05 - 1.18），<0.001）与术后并发症独立相关。
围手术期血糖状态，即术前即刻BG较低和术后平均BG较高，与非ICU的T2D患者术后并发症发生率增加相关。
