Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery.
OBJECTIVE
To determine the relationship between preoperative glucose levels and perioperative mortality in noncardiac, nonvascular surgery.


METHODS
We performed a case-control study in a cohort of 108 593 patients who underwent noncardiac surgery at the Erasmus MC during 1991-2001. Cases were 989 patients who underwent elective noncardiac, nonvascular surgery and died within 30 days during hospital stay. From the remaining patients, 1879 matched controls (age, sex, calendar year, and type of surgery) were selected. Information was obtained regarding the presence of cardiac risk factors, medication, and preoperative laboratory results. Preoperative random glucose levels <5.6 mmol/l (110 mg/dl) were normal. Impaired glucose levels in the range of 5.6-11.1 mmol/l were prediabetes. Glucose levels >or=11.1 mmol/l (200 mg/dl) were diabetes.


RESULTS
Preoperative glucose levels were available in 904 cases and 1247 controls. A cardiovascular complication was the primary cause of death in 207 (23%) cases. Prediabetes glucose levels were associated with a 1.7-fold increased mortality risk compared with normoglycemic levels (adjusted odds ratio (OR) 1.7 and 95% confidence interval (CI) 1.4-2.1; P<0.001). Diabetes glucose levels were associated with a 2.1-fold increased risk (adjusted OR 2.1 and 95% CI 1.3-3.5; P<0.001). In cases with cardiovascular death, prediabetes glucose levels had a threefold increased cardiovascular mortality risk (adjusted OR 3.0 and 95% CI 1.7-5.1) and diabetes glucose levels had a fourfold increased cardiovascular mortality risk (OR 4.0 and 95% CI 1.3-12).


CONCLUSIONS
Preoperative hyperglycemia is associated with increased (cardiovascular) mortality in patients undergoing noncardiac, nonvascular surgery.
Noordzij
Peter G
PG
Department of Anesthesiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Boersma
Eric
E
Schreiner
Frodo
F
Kertai
Miklos D
MD
Feringa
Harm H H
HH
Dunkelgrun
Martin
M
Bax
Jeroen J
JJ
Klein
Jan
J
Poldermans
Don
D
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000401:mortality; D016022:Case-Control Studies; D003625:Data Collection; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000401:mortality*; D007432:Intraoperative Period / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*
D001786:Blood Glucose