January 1, 2007
View Full PaperIncreased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery
Structured PICO
Are elevated preoperative glucose levels associated with increased perioperative mortality in patients undergoing noncardiac, nonvascular surgery?
P
Population
2,868 patients (989 cases, 1879 matched controls) who underwent elective noncardiac, nonvascular surgery at Erasmus MC during 1991-2001. Cases were patients who died within 30 days during hospital stay.
I
Intervention
Preoperative prediabetes (glucose 5.6-11.1 mmol/l) or diabetes (glucose ≥11.1 mmol/l) levels
C
Comparator
Preoperative normal glucose levels (<5.6 mmol/l)
O
Outcome
Perioperative mortality (death within 30 days during hospital stay)hard clinical
Preoperative hyperglycemia (both prediabetes and diabetes ranges) is significantly associated with increased 30-day perioperative mortality, including cardiovascular death, in patients undergoing noncardiac, nonvascular surgery.
Abstract
OBJECTIVE: To determine the relationship between preoperative glucose levels and perioperative mortality in noncardiac, nonvascular surgery. RESEARCH DESIGN AND METHODS: We performed a case-control study in a cohort of 108 593 patients who underwent noncardiac surgery at the Erasmus MC during 1991-2001. Cases were 989 patients who underwent elective noncardiac, nonvascular surgery and died within 30 days during hospital stay. From the remaining patients, 1879 matched controls (age, sex, calendar year, and type of surgery) were selected. Information was obtained regarding the presence of cardiac risk factors, medication, and preoperative laboratory results. Preoperative random glucose levels or=11.1 mmol/l (200 mg/dl) were diabetes. RESULTS: Preoperative glucose levels were available in 904 cases and 1247 controls. A cardiovascular complication was the primary cause of death in 207 (23%) cases. Prediabetes glucose levels were associated with a 1.7-fold increased mortality risk compared with normoglycemic levels (adjusted odds ratio (OR) 1.7 and 95% confidence interval (CI) 1.4-2.1; P<0.001). Diabetes glucose levels were associated with a 2.1-fold increased risk (adjusted OR 2.1 and 95% CI 1.3-3.5; P<0.001). In cases with cardiovascular death, prediabetes glucose levels had a threefold increased cardiovascular mortality risk (adjusted OR 3.0 and 95% CI 1.7-5.1) and diabetes glucose levels had a fourfold increased cardiovascular mortality risk (OR 4.0 and 95% CI 1.3-12). CONCLUSIONS: Preoperative hyperglycemia is associated with increased (cardiovascular) mortality in patients undergoing noncardiac, nonvascular surgery.