Early postoperative hyperglycaemia is not a risk factor for infectious complications and prolonged in-hospital stay in patients undergoing oesophagectomy: a retrospective analysis of a prospective trial.
BACKGROUND
Treating hyperglycaemia in hospitalized patients has proven to be beneficial, particularly in those with obstructive vascular disease. In a cohort of patients undergoing resection for oesophageal carcinoma (a group of patients with severe surgical stress but a low prevalence of vascular disease), we investigated whether early postoperative hyperglycaemia is associated with increased incidence of infectious complications and prolonged in-hospital stay.


METHODS
Postoperative glucose values up to 48 hours after surgery were retrieved for 151 patients with American Society of Anesthesiologists class I or II who had been previously included in a randomized trial conducted in a tertiary referral hospital. Multivariate regression analysis was used to define the independent contribution of possible risk factors selected by univariate analysis.


RESULTS
In univariate regression analysis, postoperative glucose levels were associated with increased length of in-hospital stay (P < 0.001) but not with infectious complications (P = 0.21). However, postoperative glucose concentration was not found to be an independent risk factor for prolonged in-hospital stay in multivariate analysis (P = 0.20).


CONCLUSIONS
Our data indicate that postoperative hyperglycaemia is more likely to be a risk marker than a risk factor in patients undergoing highly invasive surgery for oesophageal cancer. We hypothesize that patients with a low prevalence of vascular disease may benefit less from intensive insulin therapy.
Vriesendorp
Titia M
TM
Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands. T.M.Vriesendorp@amc.uva.nl
DeVries
J Hans
JH
Hulscher
Jan B F
JB
Holleman
Frits
F
van Lanschot
Jan J
JJ
Hoekstra
Joost B L
JB
D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000503:physiopathology; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology
D001786:Blood Glucose