Liu Siyuan, Shi Likai, Wang Binbin, Lou Jingsheng, Sun Miao, Yang Huikai, Zhang Faqiang, Liu Min, Song Yuxiang, Mi Weidong, Ma Yulong
Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China.
Front Aging Neurosci. 2022 Oct 20;14:990567. doi: 10.3389/fnagi.2022.990567. eCollection 2022.
Diabetes mellitus (DM) has been reported to be associated with perioperative stroke, but the effects of preoperative hyperglycemia on the risk of perioperative stroke in diabetic patients undergoing non-cardiovascular surgery remain unclear. This study investigated the association between preoperative hyperglycemia and the risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery.
This retrospective cohort study screened 27,002 patients with type 2 DM undergoing non-cardiovascular surgery with general anesthesia between January 2008 and August 2019 at The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital. The exposure of interest was preoperative hyperglycemia, defined as a fasting plasma glucose (FPG) ≥ 7 mmol/L. The outcome of interest was a new diagnosis of perioperative ischemic stroke within 30 days after surgery. Residual confounding was minimized by controlling for observable patient and intraoperative factors. Logistic regression was conducted in the total and propensity score matched cohorts. In addition, we stratified patients into six subgroups to investigate whether the association between preoperative hyperglycemia and perioperative ischemic stroke differs in these subgroups.
The overall incidence of perioperative ischemic stroke was 0.53% ( = 144) in the current cohort. The odds of perioperative ischemic stroke were significantly increased for patients with preoperative hyperglycemia after adjusting for patient- related variables (OR: 1.95; 95% CI: 1.39-2.75; < 0.001), surgery-related variables (OR: 2.1; 95% CI: 1.51-2.94; < 0.001), and all confounding variables (OR: 1.78; 95% CI: 1.26-2.53; < 0.001). The risk of perioperative stroke was significantly increased in patients with preoperative hyperglycemia (OR: 2.51; 95% CI: 1.66-3.9; < 0.001) in the propensity score matched cohort. Preoperative hyperglycemia was associated with the outcome for all the subgroups except for patients undergoing neurosurgery.
Preoperative hyperglycemia is associated with an elevated risk of perioperative stroke in patients with type 2 DM undergoing non-cardiovascular surgery. The effect could be eliminated for patients undergoing neurosurgery, during which specific risk factors should be considered.
据报道，糖尿病（DM）与围手术期卒中有关，但术前高血糖对接受非心血管手术的糖尿病患者围手术期卒中风险的影响尚不清楚。本研究调查了接受非心血管手术的2型糖尿病患者术前高血糖与围手术期缺血性卒中风险之间的关联。
这项回顾性队列研究筛选了2008年1月至2019年8月期间在中国人民解放军总医院第一医学中心接受全身麻醉的非心血管手术的27002例2型糖尿病患者。感兴趣的暴露因素是术前高血糖，定义为空腹血糖（FPG）≥7 mmol/L。感兴趣的结局是术后30天内新诊断的围手术期缺血性卒中。通过控制可观察到的患者和术中因素，将残余混杂因素降至最低。在总队列和倾向评分匹配队列中进行逻辑回归。此外，我们将患者分为六个亚组，以研究术前高血糖与围手术期缺血性卒中之间的关联在这些亚组中是否不同。
在当前队列中，围手术期缺血性卒中的总体发生率为0.53%（n = 144）。在调整了患者相关变量（OR：1.95；95%CI：1.39 - 2.75；P < 0.001）、手术相关变量（OR：2.1；95%CI：1.51 - 2.94；P < 0.001）和所有混杂变量（OR：1.78；95%CI：1.26 - 2.53；P < 0.001）后，术前高血糖患者围手术期缺血性卒中的几率显著增加。在倾向评分匹配队列中，术前高血糖患者围手术期卒中风险显著增加（OR：2.51；95%CI：1.66 - 3.9；P < 0.001）。除神经外科手术患者外，术前高血糖与所有亚组的结局均相关。
术前高血糖与接受非心血管手术的2型糖尿病患者围手术期卒中风险升高有关。对于接受神经外科手术的患者，这种影响可能会消除，在此期间应考虑特定的风险因素。
