High preoperative HbA1c levels were associated with postoperative glucose level checks, and insulin use and early postoperative hyperglycemia were tied to increased readmission in adults who underwent gastrointestinal surgical procedures, according to a study.
Mary T. Hawn, MD, MPH, FACS, Stanford Medicine professor of surgery and chair of the department of surgery at Stanford University, and colleagues evaluated data from 117 Veterans Affairs hospitals from 2007 to 2014 on 21,541 adults (mean age, 63.7 years; 5.5% women) who underwent gastrointestinal surgical procedures to determine the use of preoperative HbA1c and early postoperative glucose levels for predicting postoperative complications and readmission.
Participants with diabetes who were insulin-dependent had a higher BMI (P < .001) and experienced more postoperative complications (P < .001), more 30-day readmissions (P < .001), higher preoperative glucose levels (P < .001), initial postoperative glucose levels (P < .001) and peak 48-hour postoperative glucose levels (P < .001) compared with participants without diabetes and participants with diabetes who were not insulin-dependent. Mean HbA1c was 6.7%: 7% among participants with diabetes who were not insulin-dependent and 8% among participants with diabetes who were insulin-dependent. Mean HbA1c was 5.9% among participants who did not receive a preoperative diagnosis of diabetes; 37.8% had an HbA1c of 5.7% or less, 51.4% had an HbA1c ranging from 5.7% to 6.4% and 10.8% had an HbA1c greater than 6.5%.
Postoperative complications (OR = 0.89; 95% CI, 0.8-0.99) and readmission within 30 days (OR = 0.85; 95% CI, 0.74-0.96) were less likely among participants with an HbA1c greater than 6.5% compared with those with a normal HbA1c (< 5.7%).
The frequency of 48-hour postoperative glucose checks increased as preoperative HbA1c increased (P < .001)
“These findings advocate for increased glycemic monitoring in the early postoperative phase and early treatment of hyperglycemia to maintain peak blood glucose levels of less than 250 mg/dL to minimize the risk for complications because of hyperglycemia,” the researchers wrote. “Further study is warranted to address causation.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.