Key result
Preoperative hyperglycemia linked to ~78% higher perioperative ischemic stroke risk in T2D undergoing non-CV surgery.
Why the study?
The effects of preoperative hyperglycemia on perioperative stroke risk in diabetic patients undergoing non-cardiovascular surgery remained unclear.
Does preoperative hyperglycemia increase the risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery?
Cohort (n=27,002)
No
Does preoperative hyperglycemia increase the risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery?
Odds Ratio: 1.78 (95% CI 1.26–2.53)
Absolute Event Rate: 0.8% vs 0.38%
p-value: p=<0.001
Preoperative hyperglycemia (FPG ≥ 7 mmol/L) is an independent risk factor for perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery.
Should not yet change perioperative management; hypothesis-generating for RCTs on preoperative glucose control in non-cardiac surgery.
Background Diabetes mellitus (DM) has been reported to be associated with perioperative stroke, but the effects of preoperative hyperglycemia on the risk of perioperative stroke in diabetic patients undergoing non-cardiovascular surgery remain unclear. This study investigated the association between preoperative hyperglycemia and the risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery. Methods This retrospective cohort study screened 27,002 patients with type 2 DM undergoing non-cardiovascular surgery with general anesthesia between January 2008 and August 2019 at The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital. The exposure of interest was preoperative hyperglycemia, defined as a fasting plasma glucose (FPG) ≥ 7 mmol/L. The outcome of interest was a new diagnosis of perioperative ischemic stroke within 30 days after surgery. Residual confounding was minimized by controlling for observable patient and intraoperative factors. Logistic regression was conducted in the total and propensity score matched cohorts. In addition, we stratified patients into six subgroups to investigate whether the association between preoperative hyperglycemia and perioperative ischemic stroke differs in these subgroups. Results The overall incidence of perioperative ischemic stroke was 0.53% (n = 144) in the current cohort. The odds of perioperative ischemic stroke were significantly increased for patients with preoperative hyperglycemia after adjusting for patient- related variables (OR: 1.95; 95% CI: 1.39–2.75; p < 0.001), surgery-related variables (OR: 2.1; 95% CI: 1.51–2.94; p < 0.001), and all confounding variables (OR: 1.78; 95% CI: 1.26–2.53; p < 0.001). The risk of perioperative stroke was significantly increased in patients with preoperative hyperglycemia (OR: 2.51; 95% CI: 1.66–3.9; p < 0.001) in the propensity score matched cohort. Preoperative hyperglycemia was associated with the outcome for all the subgroups except for patients undergoing neurosurgery. Conclusion Preoperative hyperglycemia is associated with an elevated risk of perioperative stroke in patients with type 2 DM undergoing non-cardiovascular surgery. The effect could be eliminated for patients undergoing neurosurgery, during which specific risk factors should be considered.
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Liu et al. (2022) conducted a cohort in Type 2 diabetes mellitus undergoing non-cardiovascular surgery (n=27,002). Preoperative hyperglycemia (FPG ≥ 7 mmol/L) vs. Normoglycemia (FPG < 7 mmol/L) was evaluated on Perioperative ischemic stroke within 30 days after surgery (OR 1.78, 95% CI 1.26-2.53, p=<0.001). Preoperative hyperglycemia (fasting plasma glucose ≥ 7 mmol/L) was associated with a significantly increased risk of perioperative ischemic stroke (OR 1.78) in patients with type 2 diabetes undergoing non-cardiovascular surgery.
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