Preoperative hyperglycemia is associated with elevated risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery: A retrospective cohort study

Siyuan Liu; Likai Shi; Binbin Wang; Jingsheng Lou; Miao Sun; Huikai Yang; Faqiang Zhang; Min Liu; Yuxiang Song; Weidong Mi; Yulong Ma

doi:10.3389/fnagi.2022.990567

Preoperative hyperglycemia is associated with elevated risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery: A retrospective cohort study

Front Aging Neurosci. 2022 Oct 20:14:990567. doi: 10.3389/fnagi.2022.990567. eCollection 2022.

Authors

Siyuan Liu^{1

2}, Likai Shi¹, Binbin Wang², Jingsheng Lou¹, Miao Sun¹, Huikai Yang¹, Faqiang Zhang¹, Min Liu³, Yuxiang Song¹, Weidong Mi¹, Yulong Ma¹

Affiliations

¹ Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
² Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China.
³ Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Diabetes mellitus (DM) has been reported to be associated with perioperative stroke, but the effects of preoperative hyperglycemia on the risk of perioperative stroke in diabetic patients undergoing non-cardiovascular surgery remain unclear. This study investigated the association between preoperative hyperglycemia and the risk of perioperative ischemic stroke in type 2 diabetic patients undergoing non-cardiovascular surgery.

Methods: This retrospective cohort study screened 27,002 patients with type 2 DM undergoing non-cardiovascular surgery with general anesthesia between January 2008 and August 2019 at The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital. The exposure of interest was preoperative hyperglycemia, defined as a fasting plasma glucose (FPG) ≥ 7 mmol/L. The outcome of interest was a new diagnosis of perioperative ischemic stroke within 30 days after surgery. Residual confounding was minimized by controlling for observable patient and intraoperative factors. Logistic regression was conducted in the total and propensity score matched cohorts. In addition, we stratified patients into six subgroups to investigate whether the association between preoperative hyperglycemia and perioperative ischemic stroke differs in these subgroups.

Results: The overall incidence of perioperative ischemic stroke was 0.53% (n = 144) in the current cohort. The odds of perioperative ischemic stroke were significantly increased for patients with preoperative hyperglycemia after adjusting for patient- related variables (OR: 1.95; 95% CI: 1.39-2.75; p < 0.001), surgery-related variables (OR: 2.1; 95% CI: 1.51-2.94; p < 0.001), and all confounding variables (OR: 1.78; 95% CI: 1.26-2.53; p < 0.001). The risk of perioperative stroke was significantly increased in patients with preoperative hyperglycemia (OR: 2.51; 95% CI: 1.66-3.9; p < 0.001) in the propensity score matched cohort. Preoperative hyperglycemia was associated with the outcome for all the subgroups except for patients undergoing neurosurgery.

Conclusion: Preoperative hyperglycemia is associated with an elevated risk of perioperative stroke in patients with type 2 DM undergoing non-cardiovascular surgery. The effect could be eliminated for patients undergoing neurosurgery, during which specific risk factors should be considered.

Keywords: general anesthesia; non-cardiovascular surgery; perioperative stroke; preoperative hyperglycemia; type 2 diabetes mellitus.