Perioperative Hyperglycemia and Postoperative Outcomes in Patients Undergoing Resection of Colorectal Liver Metastases

J Gastrointest Surg. 2017 Feb;21(2):228-237. doi: 10.1007/s11605-016-3278-9. Epub 2016 Sep 27.

Abstract

Introduction: There is limited evidence characterizing the impact of glycemic alterations on short-term outcomes among patients undergoing resection of colorectal liver metastases (CRLM).

Methods: Hyperglycemia was defined as a glucose value >125 mg/dl according to WHO definition. The impact of early postoperative hyperglycemia on short-term postoperative outcomes was assessed.

Results: The mean postoperative glucose value was 128 mg/dl; 30 (9.8 %) patients had normal fasting glucose (<100 mg/dl), 106 patients had glucose intolerance (100-125 mg/dl), and 170 (55.5 %) patients had hyperglycemia (>125 mg/dl). A postoperative complication occurred in 101 patients (morbidity, 33.1 %); among patients who experienced a complication, an infectious complication was most common (38.6 %). After controlling for clinical factors, patients with hyperglycemia had an increased risk of overall complications [odds ratio (OR) 4.11; 95 % confidence interval (CI) 1.96-8.62, P < 0.001]. This was the case for both patients with and without diabetes (P < 0.05). Patients with hyperglycemia on the day of surgery were also at an increased risk of infections [OR 9.17; 95 % CI 2.26-37.13, P = 0.002] and had a longer hospital stay (normal glucose, 4 days vs. glucose 100-125 mg/dl, 4 days vs. glucose >125 mg/dl, 5 days, P < 0.001).

Conclusions: Early postoperative hyperglycemia was associated with adverse outcomes in patients with and without diabetes who underwent resection of CRLM. Perioperative glucose evaluation may be an important quality target.

Keywords: CRLM; Hyperglycemia; Short-term outcomes.

MeSH terms

  • Aged
  • Blood Glucose / analysis
  • Colorectal Neoplasms / blood
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / surgery*
  • Diabetes Mellitus / blood*
  • Female
  • Hepatectomy / adverse effects*
  • Humans
  • Hyperglycemia / blood*
  • Hyperglycemia / complications
  • Liver Neoplasms / blood
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Perioperative Period
  • Postoperative Period
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Blood Glucose