Perioperative Hyperglycemia Predicts Postoperative Complications only in Non-Diabetics

by Joseph Esherick, M.D., FAAFP, FHM

Perioperative Hyperglycemia Predicts Postoperative Complications only in Non-Diabetics

Limited research has suggested that nondiabetic surgical patients who develop perioperative hyperglycemia are at above-average risk for postoperative complications. In this retrospective study, researchers examined the relation between perioperative glucose levels and adverse events in both diabetic and nondiabetic patients. Bariatric, abdominal, vascular, and spine surgeries were represented in this cohort, drawn from a database representing 55 hospitals in Washington State. Of 19,000 patients, 34% had diabetes; the rest were not known to have diabetes.

A composite measure of in-hospital adverse events (both cardiac and noncardiac) was analyzed according to maximal glucose level (i.e., <125, 125–180, and >180 mg/dL) during the first 2 postoperative days. Adverse events occurred in about 12% of both the diabetic and nondiabetic groups. Among diabetic patients, researchers found no association between glucose level and adverse outcomes; however, among nondiabetic patients, higher glucose levels were associated with higher rates of adverse outcomes in a “dose-response” relation.

The authors call their findings a “diabetes paradox”

Hyperglycemia and perioperative complications