Perioperative glycemic disturbances during vascular surgery in peripheral arterial disease

Background Perioperative hyperglycemia is associated with adverse postoperative outcomes, yet causal interpretation is complicated by contributions from both baseline metabolic status and the surgical stress response. Patients undergoing surgery for peripheral arterial disease often have limited physiological reserve and metabolic vulnerability. This scoping review examined how perioperative glycemia was assessed and how it related to surgical outcomes in patients undergoing surgery for peripheral arterial disease, irrespective of diabetic status. Methods A systematic search of MEDLINE (PubMed) and the Cochrane Library identified studies of adults undergoing peripheral arterial disease-related surgery addressing perioperative glycemia or glycemic interventions in relation to clinical outcomes. Inclusion required glycemic measurements with a clearly defined perioperative temporal relationship to surgery and permitted participants irrespective of diabetes status. Study selection followed PRISMA-ScR guidelines, with descriptive synthesis of glycemic measures, interventions, and outcomes. Results Of 1,017 records screened, 22 studies comprising 69,527 patients were included. Use of the term "perioperative" varied across studies, describing temporal relationships to surgery. HbA1c commonly characterized baseline metabolic status, whereas postoperative blood glucose was used to reflect the surgical stress response. Association studies were heterogeneous but consistently linked hyperglycemia, whether baseline or postoperative, to worse outcomes, whereas diabetes diagnosis alone was less consistently associated with risk. Interventional studies were few and small, targeting the surgical stress response. Hyperglycemia thresholds varied widely and were derived from clinical management guidelines rather than surgical risk stratification. Conclusion Hyperglycemia correlates with adverse outcomes in peripheral arterial disease-related surgery, but current research seldom distinguishes between baseline metabolic vulnerability and stress-induced hyperglycemia. Understanding this difference requires studies that not only measure both hyperglycemia types but also analyze their interaction and test baseline interventions.