The prevalence of hyperglycemia and its association with perioperative outcomes in gynecologic surgery: a retrospective cohort study.

Autor: Chaves KF; Division of Gynecology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, 37212, USA. katherine.chaves@vumc.org., Panza JR; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA., Olorunfemi MA; Meharry Medical College, Nashville, TN, USA., Helou CM; Division of Gynecology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, 37212, USA., Apple AN; Vanderbilt University School of Medicine, Nashville, TN, USA., Zhao Z; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA., Sorabella LL; Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA., Dumas SD; Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA., Adam RA; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA., Prescott LS; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
Jazyk: angličtina
Zdroj: Perioperative medicine (London, England) [Perioper Med (Lond)] 2023 Jun 02; Vol. 12 (1), pp. 19. Date of Electronic Publication: 2023 Jun 02.
DOI: 10.1186/s13741-023-00307-1
Abstrakt: Background: Preoperative hyperglycemia has been associated with perioperative morbidity in general surgery patients. Additionally, preoperative hyperglycemia may indicate underlying impaired glucose metabolism. Thus, identification of preoperative hyperglycemia may provide an opportunity to mitigate both short-term surgical and long-term health risk. We aimed to study this phenomenon specifically in the gynecologic surgery population. Specifically, we aimed to evaluate the association between preoperative hyperglycemia and perioperative complications in gynecologic surgery patients and to characterize adherence to diabetes screening guidelines.
Methods: This retrospective cohort study included 913 women undergoing major gynecologic surgery on an enhanced recovery pathway from January 2018 to July 2019. The main exposure was day of surgery glucose ≥ 140 g/dL. Multivariate regression identified risk factors for hyperglycemia and composite and wound-specific complications.
Results: Sixty-seven (7.3%) patients were hyperglycemic. Diabetes (aOR 24.0, 95% CI 12.3-46.9, P < .001) and malignancy (aOR 2.3, 95% CI 1.2-4.5, P = .01) were associated with hyperglycemia. Hyperglycemia was not associated with increased odds of composite perioperative (aOR 1.3, 95% CI 0.7-2.4, P = 0.49) or wound-specific complications (aOR 1.1, 95% CI 0.7-1.5, P = 0.76). Of nondiabetic patients, 391/779 (50%) met the USPSTF criteria for diabetes screening; 117 (30%) had documented screening in the preceding 3 years. Of the 274 unscreened patients, 94 (34%) had day of surgery glucose levels suggestive of impaired glucose metabolism (glucose ≥ 100 g/dL).
Conclusion: In our study cohort, the prevalence of hyperglycemia was low and was not associated with higher risk of composite or wound-specific complications. However, adherence to diabetes screening guidelines was poor. Future studies should aim to develop a preoperative blood glucose testing strategy that balances the low utility of universal glucose screening with the benefit of diagnosing impaired glucose metabolism in at-risk individuals.
(© 2023. The Author(s).)
Databáze: MEDLINE
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