Poor glycemic control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgery
| Autor: | Chandler A. Long, Elizabeth W. Duggan, Shipra Arya, Frances Y. Hu, Zachary B. Fang, Luke P. Brewster, Yazan Duwayri |
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| Rok vydání: | 2019 |
| Předmět: |
Blood Glucose
Male Reoperation medicine.medical_specialty Time Factors Databases Factual medicine.medical_treatment Population 030209 endocrinology & metabolism Carotid endarterectomy 030204 cardiovascular system & hematology Revascularization Patient Readmission Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Diabetes mellitus medicine Humans Hypoglycemic Agents education Aged Retrospective Studies Glycemic education.field_of_study business.industry Perioperative Middle Aged Vascular surgery medicine.disease Surgery Treatment Outcome Hyperglycemia Female Metabolic syndrome Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Biomarkers |
| Zdroj: | Journal of Vascular Surgery. 69:1219-1226 |
| ISSN: | 0741-5214 |
| Popis: | Hyperglycemia is a common occurrence in patients undergoing cardiovascular surgery. It has been identified in several surgical cohorts that improved perioperative glycemic control reduced postoperative morbidity and mortality. A significant portion of the population with peripheral arterial disease suffers from the sequelae of diabetes or metabolic syndrome. A paucity of data exists regarding the relationship between perioperative glycemic control and postoperative outcomes in vascular surgery patients. The objective of this study was to better understand this relationship and to determine which negative perioperative outcomes could be abated with improved glycemic control.This is a retrospective review of a vascular patient database at a large academic center from 2009 to 2013. Eligible procedures included carotid endarterectomy and stenting, endovascular and open aortic aneurysm repair, and all open bypass revascularization procedures. Data collected included standard demographics, outcome parameters, and glucose levels in the perioperative period. Perioperative hyperglycemia was defined as at least one glucose value 180 mg/dL within 72 hours of surgery. The primary outcome was 30-day mortality, with secondary outcomes of complications, need to return to the operating room, and readmission.Of the total 1051 patients reviewed, 366 (34.8%) were found to have perioperative hyperglycemia. Hyperglycemic patients had a higher 30-day mortality (5.7% vs 0.7%; P .01) and increased rates of acute renal failure (4.9% vs 0.9%; P .01), postoperative stroke (3.0% vs 0.7%; P .01), and surgical site infections (5.7% vs 2.6%; P = .01). In addition, these patients were also more likely to undergo readmission (12.3% vs 7.9%; P = .02) and reoperation (6.3% vs 1.8%; P .01). Furthermore, multivariable logistic regression demonstrated that perioperative hyperglycemia had a strong association with increased 30-day mortality and multiple negative postoperative outcomes, including myocardial infarction, stroke, renal failure, and wound complications.This study demonstrates a strong association between perioperative glucose control and 30-day mortality in addition to multiple other postoperative outcomes after vascular surgery. |
| Databáze: | OpenAIRE |
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