title: Association of postoperative hyperglycemia with outcomes among patients with complex ventral hernia repair.
abstract: OBJECTIVE
  Patients with medically complex conditions undergoing repair of large or recurrent hernia of the abdominal wall are at risk for early postoperative hyperglycemia, which may serve as an early warning for delays in recovery and for adverse outcomes.
  
  
  OBJECTIVE
  To evaluate postoperative serum glucose level as a predictor of outcome after open ventral hernia repair in patients with major medical comorbidities.
  
  
  METHODS
  We performed a retrospective medical record review of 172 consecutive patients who underwent open ventral hernia repair at Penn State Milton S. Hershey Medical Center, an academic tertiary referral center, from May 1, 2011, through November 30, 2013. We initially identified patients by medical complexity and repair requiring a length of stay of longer than 1 day.
  
  
  METHODS
  Postoperative recovery variables, including time to the first solid meal, length of stay, total costs of hospitalization, and surgical site occurrence.
  
  
  RESULTS
  Postoperative serum glucose values were available for 136 patients (79.1%), with 130 (95.6%) obtained within 48 hours of surgery. Among these patients, Ventral Hernia Working Group grade distributions included 8 patients with grade 1, 79 with grade 2, 41 with grade 3, and 8 with grade 4. Fifty-four patients (39.7%) had a postoperative glucose level of at least 140 mg/dL, and 69 patients (50.7%) required insulin administration. Both outcomes were associated with delays in the interval to the first solid meal (glucose level, ≥140 vs <140 mg/dL: mean [SD] delay, 6.4 [5.3] vs 5.6 [8.2] days; P = .01; ≥2 insulin events vs <2: 6.5 [5.5] vs 5.4 [8.4] days; P = .02); increased length of stay (glucose level, ≥140 vs <140 mg/dL: mean [SD], 8.0 [6.0] vs 6.9 [8.2] days; P = .008; ≥2 insulin events vs <2: 8.3 [6.1] vs 6.5 [8.4] days; P < .001); increased costs of hospitalization (glucose level, ≥140 vs <140 mg/dL: mean [SD], $31 307 [$20 875] vs $22 508 [$22 531]; P < .001; ≥2 insulin events vs <2: $31 943 [$22 224] vs $20 651 [$20 917]; P < .001); and possibly increased likelihood of surgical site occurrence (glucose level, ≥140 vs <140 mg/dL: 37.5% [21 of 56 patients] vs 22.5% [18 of 80 patients]; P = .06; ≥2 insulin events vs <2: 36.4% [24 of 66 patients] vs 21.4% [15 of 70 patients]; P = .06). Not all patients with diabetes mellitus developed postoperative hyperglycemia or needed more intense insulin therapy; however, 46.4% of the patients who developed postoperative hyperglycemia were not previously known to have diabetes mellitus, although most had at least 1 clinical risk factor for a prediabetic condition.
  
  
  CONCLUSIONS
  Postoperative hyperglycemia was associated with outcomes in patients in this study who underwent complex ventral hernia repair and may serve as a suitable target for screening, benchmarking, and intervention in patient groups with major comorbidities.
authors.affiliation: Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey.
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Won
authors.affiliation: Department of Public Health Services, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Lehman
authors.affiliation: Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey.
authors.forename: Abby K
authors.initials: AK
authors.lastname: Geletzke
authors.affiliation: Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Tangel
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey.
authors.forename: Deborah
authors.initials: D
authors.lastname: Brunke-Reese
authors.affiliation: Department of Medicine, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey.
authors.forename: Ariana R
authors.initials: AR
authors.lastname: Pichardo-Lowden
authors.affiliation: Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Pauli
authors.affiliation: Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey.
authors.forename: David I
authors.initials: DI
authors.lastname: Soybel
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose