|
Back to 2016 Annual Meeting
Impact of Early Postoperative Hyperglycemia on Short-Term Outcomes After Resection of Colorectal Liver Metastases
Georgios A. Margonis*, Neda Amini, Kazunari Sasaki, Ana Wilson, Mario Samaha, Yuhree Kim, Timothy M. Pawlik
Surgery, Johns Hopkins Hospital, Baltimore, MD
INTRODUCTION: The influence of perioperative hyperglycemia on short-term outcomes of patients undergoing liver resection for colorectal cancer liver metastases (CRLM) remains largely unknown. We sought to study the impact of immediate postoperative hyperglycemia on perioperative outcomes following resection of CRLM.
METHODS: 306 patients who underwent hepatic resection with curative intent for CRLM between 2010-2015 at Johns Hopkins and who had data on glucose values available within 6 hours after surgery were identified. Demographics, operative details, and short-term outcomes were collected and analyzed. Hyperglycemia was defined as a glucose value >125mg/dl according to WHO definition. The incidence, as well as type and grade, of complications and in-hospital length of stay were assessed relative to immediate postoperative glucose values using Chi-square or Wilcoxon rank-sum test.
RESULTS: Median patient age was 56.3 (IQR 47.1,65.7) years and the majority of patients were male (54.6%, n=167). The mean postoperative glucose value immediately following surgery was 128mg/dl; 33 (10.8%) patients had a normal fasting glucose value (<100mg/dl), 106 patients had glucose intolerance (100-125mg/dl), and 167 (54.6%) patients had hyperglycemia (>125mg/dl). A postoperative complication occurred in 101 patients for a morbidity of 33.1 %; the most common complications were infectious complications (38.6%). Early postoperative hyperglycemia (>125mg/dl) was associated with postoperative complications (normal glucose, 6.1% vs. glucose 100-125, 17.9% vs. glucose >125mg/dl, 48.2%;P<0.001)(Figure 1). Patients with early postoperative hyperglycemia had an increased risk of overall infectious complications (normal glucose, 3.1% vs glucose 100-125, 3.3% vs. glucose> 125, 21.8;P<0.001) and surgical site infections (normal glucose, 0% vs glucose 100-125mg/dl, 2.3% vs. glucose >125mg/dl, 9.5%;P=0.03). Grade of complication was comparable between patients with early hyperglycemia and normal glucose values (P=0.67). Among patients without a history of diabetes mellitus, early postoperative hyperglycemia remained associated with the overall incidence of complications (normal glucose, 6.5% vs. glucose 100-125mg/dl, 16.3% vs. glucose >125mg/dl, 48.1%;P<0.001) and overall infectious complications (normal glucose, 3.3% vs. glucose 100-125md/dl, 3.8% vs. glucose >125mg/dl, 22.5%;P<0.001). Patients with early postoperative hyperglycemia also had a longer hospital stay (normal glucose, 4 days vs. glucose 100-125mg/dl, 4 days vs. glucose >125mg/dl, 5 days;P<0.001)(Figure 2).
CONCLUSIONS: Early postoperative hyperglycemia was associated with overall postoperative complications, as well as infectious complications, after hepatic resection of CRLM. Immediate postoperative hyperglycemia may be an early indicator to identify patients at increased risk for worse short-term outcomes.
Figure 1
  Figure 1
Figure 2
Back to 2016 Annual Meeting
|
