Ayla Y. Stobbe1, Malachy O. Columb2, Donal J. Buggy3,4, Jeroen Hermanides5, MOPED Investigators
1: Department of Endocrinology, Research Institutes Amsterdam Gastroenterology, Endocrinology and Metabolism & Amsterdam Public Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands. 5: Department of Anaesthesiology, Research Institutes Amsterdam Cardiovascular Sciences & Amsterdam Public Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
Background and objective: Acute perioperative hyperglycaemia is associated with adverse postoperative outcomes. However, this does not take into account the impact of long-term preoperative glucose regulation, and there is growing evidence that long term preoperative glucose regulation impacts the way hyperglycaemia should be treated during surgery. The objective of this study was to evaluate the associations between long-term glycaemic control before surgery, as measured by HbA1c, and perioperative glycaemic control on days at home at 30 days postoperatively (DAH-30) and surgical site infections.
Methods: In this secondary analysis of the MOPED trial, patients were stratified in three groups by their preadmission glycaemic control status, defined as their HbA1c level. Glucose values intraoperative, at the post anaesthesia care unit and postoperatively were divided into quintiles to perform quantile regression and chi-square trend analyses.
Results: Higher perioperative glucose values reduced DAH-30 in the overall study population (slope -1.0 day (95%CI -1.15 to -0.85) for post anaesthesia care unit glucose values per quintile of glucose) and in patients with HbA1c <53 and 53-69 mmol.mol-1. Patients with HbA1c >69 mmol.mol-1 did not show this association (0.0 days (95%CI -0.58 to 0.58)). Similar results were found for the effect of highest intraoperative and postoperative glucose values after PACU stay. The effect of higher perioperative glucose values showed higher incidences of surgical site infections for both HbA1c <53 and 53-69 mmol.mol-1. For patients with HbA1c >69 mmol.mol-1, the opposite effect was found with a lower incidence of SSI as the perioperative glucose values were higher.
Discussion/conclusion: The findings of this study show that patients with worse long-term glycaemic control (HbA1c >69 mmol.mol-1 ) might need a different, personalised approach in the perioperative setting, perhaps allowing glucose values to be higher compared to well-regulated patients with diabetes.