Kincaid Kaitlyn, Boitano Teresa K L, Scalise Matthew, Patton Samantha, Leath Charles A, Straughn John M, Smith Haller J
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States.
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States.
Gynecol Oncol Rep. 2024 Feb 18;52:101344. doi: 10.1016/j.gore.2024.101344. eCollection 2024 Apr.
We aimed to assess the impact of preoperative steroid administration and perioperative glycemic control on postoperative complications in diabetic gynecologic oncology patients undergoing laparotomy.
This retrospective cohort study included gynecologic oncology patients with Type I and Type II diabetes (DM) undergoing laparotomy for any gynecologic indication at a single academic center from 10/2017 to 09/2020. The primary outcome was the rate of postoperative complications. Preoperative steroid administration and 24-hour postoperative average serum blood glucose (BG) ≥ 180 mg/dL were the studied exposures. Data was analyzed with SPSS Statistics v.28.
225 patients met inclusion criteria; 47.6 % had postoperative complications. Patient demographics were similar between patients with and without postoperative complications. Patients with complications had higher BMIs (36.8 vs. 34.0; p = 0.03), bowel surgery (33.0 % vs. 17.1 %; p = 0.008), operative time ≥ 240 min (14.2 % vs. 5.1 %; p = 0.02) and average BG ≥ 180 (63.6 % vs. 40.2 %; p < 0.01). On multivariate analysis, bowel surgery (OR 2.4 (1.2-4.8); p = 0.01) and average BG ≥ 180 (OR 2.8 (1.6-4.9); p < 0.01) remained significant predictors of postoperative complications. There were no differences in complication rates (42.3 % vs. 42.6 %; p = 1.0) between patients who received preoperative steroids and those who did not. When stratified by average postoperative BG < 180 mg/dL vs. BG ≥ 180 mg/dL, there was no difference in Clavien-Dindo classification, 30-day readmission rate (28.2 % vs. 22.1 %; p = 0.49) or 30-day mortality rate (2.9 % vs. 0.0 %; p = 0.53).
The administration of preoperative steroids did not increase complication rates. Perioperative hyperglycemia was associated with an increased risk of postoperative complications. Optimizing perioperative glycemic control is imperative to decrease postoperative complications.
我们旨在评估术前给予类固醇激素及围手术期血糖控制对接受剖腹手术的糖尿病妇科肿瘤患者术后并发症的影响。
这项回顾性队列研究纳入了2017年10月至2020年9月期间在单一学术中心因任何妇科指征接受剖腹手术的I型和II型糖尿病（DM）妇科肿瘤患者。主要结局是术后并发症发生率。术前给予类固醇激素及术后24小时平均血清血糖（BG）≥180 mg/dL是研究的暴露因素。数据采用SPSS Statistics v.28进行分析。
225例患者符合纳入标准；47.6%发生了术后并发症。有术后并发症和无术后并发症的患者的人口统计学特征相似。发生并发症的患者BMI更高（36.8 vs. 34.0；p = 0.03），接受肠道手术的比例更高（33.0% vs. 17.1%；p = 0.008），手术时间≥240分钟的比例更高（14.2% vs. 5.1%；p = 0.02），平均BG≥180的比例更高（63.6% vs. 40.2%；p < 0.01）。多因素分析显示，肠道手术（OR 2.4（1.2 - 4.8）；p = 0.01）和平均BG≥180（OR 2.8（1.6 - 4.9）；p < 0.01）仍然是术后并发症的显著预测因素。接受术前类固醇激素治疗的患者与未接受治疗的患者之间的并发症发生率无差异（42.3% vs. 42.6%；p = 1.0）。当按术后平均BG < 180 mg/dL与BG≥180 mg/dL分层时，Clavien-Dindo分类、30天再入院率（28.2% vs. 22.1%；p = 0.49）或30天死亡率（2.9% vs. 0.0%；p = 0.53）均无差异。
术前给予类固醇激素不会增加并发症发生率。围手术期高血糖与术后并发症风险增加相关。优化围手术期血糖控制对于降低术后并发症至关重要。
