title: Clinical Significance of Post-Operative Hyperglycemia in Nondiabetic Patients Undergoing Definitive Surgery for Gastrointestinal Fistula.
abstract: BACKGROUND
  To evaluate the association between peri-operative hyperglycemia and adverse events in patients with gastrointestinal (GI) fistulas without a pre-operative diagnosis of diabetes mellitus who were undergoing definitive surgery.
  
  
  METHODS
  Pre-operative and all post-operative blood glucose concentrations (BG) were retrieved for 363 consecutive patients undergoing GI reconstruction from September 2012 to December 2015. Normoglycemic (BG <125 mL/dL), mild hyperglycemia (125-199 mL/dL), and severe hyperglycemia (≥200 mL/dL) were defined using the highest BG found within the first 48 h post-operatively. Outcomes of interest included 30-d mortality rate and re-operation, time of enteral nutrition resumption, and infectious and non-infectious complications.
  
  
  RESULTS
  More than half of the nondiabetic patients (61.4%) experienced hyperglycemia post-operatively. The degree of hyperglycemia correlated with patient age, American Society of Anesthesiologists class, and surgical interventions. Hyperglycemia was associated with re-operation and post-operative complications, the frequency of these complications increasing in parallel with the degree of hyperglycemia. Additionally, post-operative hyperglycemia was associated independently with surgical site infections (p = 0.014), anastomotic leak (p = 0.010), delayed resumption of enteral nutrition (p < 0.001), and longer hospital stay (p < 0.001).
  
  
  CONCLUSIONS
  Elevated post-operative BG was frequent after surgery in patients with GI fistulas. Post-operative hyperglycemia is significantly associated with unfavorable outcomes, and this risk is related to the degree of BG elevation. Our findings suggest that vigilant post-operative BG monitoring and early appropriate glycemic control are critical for patients, even nondiabetic patients, undergoing definitive surgery for GI fistula.
authors.affiliation: 1 Department of Surgery, Jinling Hospital, Medical School of Southeast University , Nanjing, China .
authors.forename: Qiongyuan
authors.initials: Q
authors.lastname: Hu
authors.affiliation: 1 Department of Surgery, Jinling Hospital, Medical School of Southeast University , Nanjing, China .|2 Medical School of Nanjing University , Nanjing, China .
authors.forename: Jianan
authors.initials: J
authors.lastname: Ren
authors.affiliation: 1 Department of Surgery, Jinling Hospital, Medical School of Southeast University , Nanjing, China .|2 Medical School of Nanjing University , Nanjing, China .
authors.forename: Guanwei
authors.initials: G
authors.lastname: Li
authors.affiliation: 1 Department of Surgery, Jinling Hospital, Medical School of Southeast University , Nanjing, China .
authors.forename: Xiuwen
authors.initials: X
authors.lastname: Wu
authors.affiliation: 1 Department of Surgery, Jinling Hospital, Medical School of Southeast University , Nanjing, China .|2 Medical School of Nanjing University , Nanjing, China .
authors.forename: Gefei
authors.initials: G
authors.lastname: Wang
authors.affiliation: 1 Department of Surgery, Jinling Hospital, Medical School of Southeast University , Nanjing, China .
authors.forename: Guosheng
authors.initials: G
authors.lastname: Gu
authors.affiliation: 1 Department of Surgery, Jinling Hospital, Medical School of Southeast University , Nanjing, China .
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D017281:Cost of Illness; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D007412:Intestinal Fistula / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome