Preoperative Glucose Levels Predict Postsurgical Mortality

High preoperative glucose levels are associated with higher mortality rates at one year after noncardiac surgery, according to a new study.

Researchers at the Cleveland Clinic (OH, USA) conducted an analysis that included 61,536 patients who were American Society of Anesthesiologists (ASA) grade I-IV and who underwent elective noncardiac surgery between January 2005 and November 2009. The researchers then used additive logistic regression models (ALRMs) to estimate the incidence of each outcome as a function of preoperative glucose, adjusted for type of surgery and baseline comorbidities. Primary outcomes were one-year mortality and a composite of in-hospital mortality and cardiovascular, neurologic, pulmonary, urological, and infectious complications.

In all, 44,461 patients completed one-year follow-up; euglycemic patients had outcome rates of 8% - 11%, whereas hyperglycemic patients had rates of 12% - 16%. However, after adjustment for covariables, in-house outcome incidence was found not to be related to preoperative glucose levels. On the other hand, patients with preoperative glucose levels in the euglycemic range (85 mg/dL), had a one-year mortality incidence of 3.5%, while in those with glucose values higher than 160 mg/dL the mortality incidence was found to be greater than 9%. The results were presented at the American Society of Anesthesiologists (ASA) annual meeting, held during October 2010 in San Diego (CA, USA).

"We wanted to confirm a relationship between glucose levels before surgery and poor outcomes in a large number of patients,” said lead author Basem Abdelmalak, M.D., of anesthesia for bronchoscopic surgery at the Cleveland Clinic. "Further studies are needed to confirm these findings and identify a plausible explanation.”

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