BARCELONA — High serum glucose levels in patients undergoing surgery were associated with significantly higher rates of death and cardiac death in a case-control study with more than 2,000 patients.
A statistical analysis showed that every 18 mg/dL increase in the preoperative glucose level was associated with a statistically significant 12% increased rate of all-cause mortality and a 14% increased rate of cardiovascular death in patients who underwent noncardiac and nonvascular surgery, Dr. Peter G. Noordzij and his associates reported in a poster at a joint meeting of the European Society of Cardiology and the World Heart Federation.
The researchers reviewed 989 patients who died during their hospitalization after noncardiac and nonvascular surgery out of the more than 100,000 patients who had this type of surgery at Erasmus Medical Center in Rotterdam, the Netherlands, during 1991–2000. These cases were matched with similar patients who underwent surgery during the same period but did not die while in the hospital. The cases and controls were matched for age, sex, type of surgery, and calendar year of surgery.
Preoperative glucose levels were available for 904 cases and 1,247 controls, and these patients were used for the analysis. Their average age was 63 years; 61% were men.
Preoperative serum glucose levels were defined as normal if they were less than 140 mg/dL, impaired if they were 140–200 mg/dL, and diabetic if they were above 200 mg/dL. The prevalence of impaired and diabetic levels of serum glucose was significantly higher in the cases, compared with the controls (see box), reported Dr. Noordzij, a physician in the department of anesthesiology at Erasmus Medical Center.
A multivariate analysis that controlled for the presence of several cardiovascular risk factors found that increasing levels of serum glucose were linked with an increased rate of all-cause death and cardiovascular death. The analysis also showed that patients with a serum glucose level that reached the diabetic level had twice the risk of dying while hospitalized after surgery, compared with patients with a normal glucose level.
ELSEVIER GLOBAL MEDICAL NEWS