Vascular Surgery Complications Increased by Hyperglycemia

Hyperglycemia can increase complications and mortality in patients undergoing vascular procedures, including those who are not diabetic, according to a new study.

Researchers at the University of Missouri (MU; Columbia, USA) conducted a study in 3,586 patients with peripheral artery disease (PAD) admitted for elective lower extremity surgical procedures performed between September 2008 and March 2014, in order to evaluate the relationship of postoperative hyperglycemia--defined as blood glucose over 180 mg/dL--with sociodemographic characteristics, acute and chronic diagnoses, infections, hospital length of stay, and 30-day readmission.

The results of the study indicated that 22% of patients undergoing vascular procedures had suboptimal glucose control (hyperglycemia), which was associated with poorer outcomes in patients both with and without diabetes, including increased infection rates (23% vs 14%) and more acute complications such as fluid and electrolyte disorders, acute renal failure, postoperative respiratory complications; increased hospital stays (6.9 vs 5.1 days); and an 8.4-times odds of dying in the hospital. The study was published on April 17, 2017, in the Journal of Vascular Surgery.

“I think of most interest was that diabetes alone was not associated with an increase in infection rates, length of stay or mortality,” said lead author Todd Vogel, MD, chief of the division of vascular surgery at MU School of Medicine. “Although more research is needed, this suggests that post–procedure hyperglycemia is a significant risk factor for outcomes following lower extremity vascular procedures. Glucose management may represent an important method for improving outcomes following surgical interventions.”

PAD is a narrowing of the peripheral arteries due to atherosclerosis, and is most common in the arteries of the pelvis and legs. The most common symptoms of PAD are cramping, pain, or tiredness in the leg or hip muscles while walking or climbing stairs, which is temporarily relieved by rest. PAD sufferers have four to five times more risk of heart attack or stroke, and if left untreated, it can lead to gangrene and amputation.

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