title: Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy.
abstract: OBJECTIVE
  To investigate the relation between perioperative hyperglycemia and complications after pancreatoduodenectomy.
  
  
  BACKGROUND
  Perioperative hyperglycemia is associated with complications after various types of surgery. This relation was never investigated for pancreatoduodenectomy.
  
  
  METHODS
  In a consecutive series of 330 patients undergoing pancreatoduodenectomy, glucose values were collected from the hospital information system during 3 periods: pre-, intra-, and early postoperative. The average glucose value per period was calculated for each patient and divided in duals according to the median group value. Odds ratios for complications were calculated for the upper versus lower dual, adjusted for age, sex, American Society of Anesthesiologists Classification, body mass index, diabetes mellitus, intraoperative blood transfusion, duration of surgery, intraoperative insulin administration, and octreotide use. The same procedures were carried out to assess the consequences of increased glucose variability, expressed by the standard deviation.
  
  
  RESULTS
  Average glucose values were 135 (preoperative), 133 (intraoperative) and 142 mg/dL (early postoperative). Pre- and intraoperative glucose values were not associated with postoperative complications. Early postoperative hyperglycemia (≥140 mg/dL) was significantly associated with complications [odds ratio (OR) 2.9, 95% confidence interval (CI), 1.7-4.9]. Overall, high glucose variability was not significantly associated with postoperative complications, but early postoperative patients who had both high glucose values and high variability had an OR for complications of 3.6 (95% CI, 1.9-6.8) compared to the lower glucose dual.
  
  
  CONCLUSIONS
  Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy. High glucose variability may enhance this risk. Future research must demonstrate whether strict glucose control in the early postoperative period prevents complications after pancreatoduodenectomy.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Wietse J
authors.initials: WJ
authors.lastname: Eshuis
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hermanides
authors.forename: Jan W
authors.initials: JW
authors.lastname: van Dalen
authors.forename: Gan
authors.initials: G
authors.lastname: van Samkar
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: J Hans
authors.initials: JH
authors.lastname: DeVries
authors.forename: Joost B L
authors.initials: JB
authors.lastname: Hoekstra
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D017677:Age Distribution; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose