title: Impact of perioperative hypoglycaemia in subjects with diabetes undergoing colorectal surgery.
abstract: BACKGROUND
  This study explores the association between perioperative hypoglycaemia and surgical outcomes in subjects with diabetes, undergoing colorectal surgery.
  
  
  METHODS
  A retrospective review of 149 subjects with Type 2 Diabetes Mellitus (DM) who underwent colorectal surgery between 2010 and 2015 was performed. Perioperative glucose levels, glycated haemoglobin (HbA1c) measurements within 3 months of surgery and surgical complications based on Clavien-Dindo classification were analysed.
  
  
  RESULTS
  The mean age was 67 years (67 ± 11.2). Perioperative hypoglycaemia was found in 7.4% of subjects. The mean HbA1c of subjects with Clavien 2 and above surgical complications were higher than patients with Clavien 1 or no complications, Hba1c 7.6% (7.6 ± 2.5%) and 7.0% (7.0 ± 1.1%, p = 0.008), respectively. Similar findings in subjects with Clavien 3 and above complications, HbA1c of 8.2% (8.2 ± 3.9%) as compared to those with Clavien 2 and below complications, 7.2% (7.2 ± 1.5%, p = 0.001). Adjusted multivariate analysis showed that hypoglycaemia was significantly associated with Clavien 2 and above surgical complications, OR of 19.0 (CI 2.23-162, p = 0.007). Preoperative hypoglycaemia was associated with Clavien 2 and above surgical complications, OR 10.7 (CI 1.22-94.1, p = 0.032). Suboptimal glycaemic control (Hba1c >8.0%) was significantly associated with Clavien 2 and above complications, OR 2.48 (CI 1.04-5.91, p = 0.04), but not with Clavien 3 and above complications, OR 1.50 (CI 0.450-4.98, p = 0.511).
  
  
  CONCLUSIONS
  Perioperative hypoglycaemia is associated with adverse surgical outcomes in diabetic patients undergoing colorectal surgery. Prevention of hypoglycaemia may improve surgical outcomes. HbA1c is an independent predictor for adverse surgical outcomes.
authors.affiliation: Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore. serene.goh@mohh.com.sg.
authors.forename: Si Ning Serene
authors.initials: SN
authors.lastname: Goh
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Ester
authors.initials: E
authors.lastname: Yeoh
authors.affiliation: Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Kok Yang
authors.initials: KY
authors.lastname: Tan
mesh_terms: D000368:Aged; D003107:Colorectal Surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000150:complications*; D008297:Male; D015999:Multivariate Analysis; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology
chemical_list: D006442:Glycated Hemoglobin
keywords: Clavien complication; Colorectal cancer; Diabetes mellitus; HbA1c; Hypoglycaemia; Perioperative