Clinical significance of perioperative hyperglycemia in bariatric surgery: evidence for better perioperative glucose management

Surg Obes Relat Dis. 2018 Nov;14(11):1725-1731. doi: 10.1016/j.soard.2018.07.028. Epub 2018 Aug 18.

Abstract

Background: Uncontrolled hyperglycemia in patients undergoing surgery has been shown to be a risk factor for postoperative complications.

Objective: To assess the clinical significance of perioperative hyperglycemia on infectious complications and clinical outcomes in patients undergoing bariatric surgery.

Setting: Single academic center.

Methods: Retrospective chart review of all patients who underwent primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2013 and 2016 was performed. The association between any elevated perioperative glucose value (hyperglycemia: ≥126 mg/dL) and level of elevation (≥126 or ≥200 mg/dL) with 30-day infectious complications, reoperation, length of hospital stay, and readmission was assessed. Patients who developed early complications (within 3 d of surgery), which could potentially lead to immediate postoperative hyperglycemia, were not included in the analysis. Outcomes of patients with and without diabetes were separately analyzed.

Results: A cohort of 1981 patients was studied, including Roux-en-Y gastric bypass (n = 1171, 59%) and sleeve gastrectomy (n = 810, 41%) patients. In patients with diabetes (n = 751, 38%), perioperative hyperglycemia was independently associated with higher composite infectious complications (defined as presence of any of 6 infectious complications; odds ratio [OR] 3.1, 95% confidence interval [CI] 1.2-8.2, P = .018) and higher readmission rate (OR 2.2, 95% CI 1.1-4.6, P = .027). In patients without diabetes (n = 1230, 62%), 19.2% had perioperative hyperglycemia (≥126 mg/dL). Perioperative hyperglycemia in patients without diabetes was associated with higher composite infectious complications (OR 2.6, 95% CI 1.1-5.5, P = .018) and prolonged length of stay (OR 3.0, 95% CI 1.5-5.9, P = .001).

Conclusions: An elevated perioperative glucose value is adversely associated with infectious complications and key clinical outcomes after bariatric surgery. The increased risk is correlated with the extent of glucose elevation (dose-response relationship). Our findings highlight the importance of glucose control during the perioperative period in bariatric surgical patients.

Keywords: Bariatric surgery; Complication; Diabetes; Glucose; Hyperglycemia; Roux-en-Y gastric bypass; Sleeve gastrectomy; Surgical site infection.

MeSH terms

  • Adult
  • Bariatric Surgery / statistics & numerical data*
  • Blood Glucose / analysis
  • Female
  • Humans
  • Hyperglycemia / epidemiology*
  • Male
  • Middle Aged
  • Perioperative Period
  • Retrospective Studies
  • Risk Factors
  • Surgical Wound Infection / epidemiology*

Substances

  • Blood Glucose