Methodological considerations regarding ‘association between preoperative hyperglycemia and adverse cardiac events after non-cardiac surgery’

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Preoperative hyperglycemia and adverse cardiac events.

Sang Gyu Kwak

doi:10.4097/kja.26225

May 19, 2026Korean journal of anesthesiologyOpen Access

Methodological considerations regarding ‘association between preoperative hyperglycemia and adverse cardiac events after non-cardiac surgery’

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Key result

Methodological considerations regarding a recent study on preoperative hyperglycemia highlight potential selection bias, variance estimation issues, and interaction term misinterpretation.

Why the study?

Does preoperative acute hyperglycemia increase the risk of adverse cardiac events following noncardiac surgery?

Key Points

To evaluate key methodological decisions, including post-exposure exclusion, variance estimation in matched cohorts, and interaction assessment, in analyses linking preoperative hyperglycemia to postoperative cardiac events.
Critique of an observational multicenter Common Data Model cohort study evaluating preoperative acute hyperglycemia and adverse cardiac events after noncardiac surgery.
Methodological assessment of the exclusion of patients experiencing adverse cardiac events or death within the first seven postoperative days.
Evaluation of variance estimation techniques in 1:2 propensity score matched samples analyzed via Cox proportional hazards models, alongside interaction term scale choices.
Excluding cardiac events or mortality within the first 7 postoperative days conditions on a post-exposure variable and risks selection bias, potentially underestimating early perioperative metabolic risk.
Analyzing 1:2 propensity-matched pairs with standard Cox proportional hazards models without robust sandwich estimators or stratification risks underestimating standard errors and yielding artificially narrow confidence intervals.
Interaction terms for age and hypertension assessed strictly on a multiplicative scale provide limited clinical utility compared to absolute risk differences and subgroup-specific event rates.

Structured PICO

Does preoperative acute hyperglycemia increase the risk of adverse cardiac events following noncardiac surgery?

P

Population

Patients undergoing noncardiac surgery

I

Intervention

Preoperative acute hyperglycemia

O

Outcome

Adverse cardiac eventshard clinical

Limitations

Exclusion of patients who experienced adverse cardiac events or mortality within the first seven postoperative days may introduce selection bias.
Failure to account for within-matched-set correlation in the Cox proportional hazards model may result in underestimated standard errors and artificially narrow CIs.
Reported interactions for age and hypertension on a multiplicative scale may not directly correspond to clinically meaningful effect modification.

Implication

Methodological issues such as selection bias and variance estimation must be carefully considered when evaluating the association between preoperative hyperglycemia and postoperative cardiac events.

Abstract

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Discussion

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Cite This Study

Sang Gyu Kwak (2026) conducted a letter in Preoperative hyperglycemia and adverse cardiac events. Methodological considerations regarding a recent study on preoperative hyperglycemia highlight potential selection bias, variance estimation issues, and interaction term misinterpretation.

synapsesocial.com/papers/6a0d531ef03e14405aa9dad1 https://doi.org/10.4097/kja.26225

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Methodological considerations regarding ‘association between preoperative hyperglycemia and adverse cardiac events after non-cardiac surgery’

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Methodological considerations regarding ‘association between preoperative hyperglycemia and adverse cardiac events after non-cardiac surgery’

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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