Influence of perioperative blood glucose levels on outcome after infrainguinal bypass surgery in patients with diabetes.
BACKGROUND
High glucose levels are associated with increased morbidity and mortality after coronary surgery and in intensive care. The influence of perioperative hyperglycaemia on the outcome after infrainguinal bypass surgery among diabetic patients is largely unknown. The aim was to determine whether high perioperative glucose levels were associated with increased morbidity after infrainguinal bypass surgery.


METHODS
Ninety-one consecutive diabetic patients undergoing primary infrainguinal bypass surgery were identified from a prospective vascular registry. Risk factors, indication for surgery, operative details and outcome data were extracted from the medical records. Exposure to perioperative hyperglycaemia was measured using the area under the curve (AUC) method; the AUC was calculated using all blood glucose readings during the first 48 h after surgery.


RESULTS
Multivariable analysis showed that the AUC for glucose (odds ratio (OR) 13.35, first versus fourth quartile), renal insufficiency (OR 4.77) and infected foot ulcer (OR 3.38) was significantly associated with poor outcome (death, major amputation or graft occlusion at 90 days). Similarly, the AUC for glucose (OR 14.45, first versus fourth quartile), female sex (OR 3.49) and tissue loss as indication (OR 3.30) was associated with surgical wound complications at 30 days.


CONCLUSIONS
Poor perioperative glycaemic control was associated with an unfavourable outcome after infrainguinal bypass surgery in diabetic patients.
Malmstedt
J
J
Department of Vascular Surgery, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden. jonas.malmstedt@karolinska.se
Wahlberg
E
E
Jörneskog
G
G
Swedenborg
J
J
D000368:Aged; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000601:surgery*; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003925:Diabetic Angiopathies / Q000097:blood / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome
D001786:Blood Glucose