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Risk Factors of Intraoperative Dysglycemia in Elderly Surgical Patients.

ABSTRACT: BACKGROUND? Dysglycemia is associated with adverse outcome including increased morbidity and mortality in surgical patients. Acute insulin resistance due to the surgical stress response is seen as a major cause of so-called stress hyperglycemia. However, understanding of factors determining blood glucose (BG) during surgery is limited. Therefore, we investigated risk factors contributing to intraoperative dysglycemia. METHODS? In this subgroup investigation of the BIOCOG study, we analyzed 87 patients of ? 65 years with tight intraoperative BG measurement every 20 min during elective surgery. Dysglycemia was defined as at least one intraoperative BG measurement outside the recommended target range of 80-150 mg/dL. Additionally, all postoperative BG measurements in the ICU were obtained. Multivariable logistic regression analysis adjusted for age, sex, American Society of Anesthesiologists (ASA) status, diabetes, type and duration of surgery, minimum Hemoglobin (Hb) and mean intraoperative norepinephrine use was performed to identify risk factors of intraoperative dysglycemia. RESULTS? 46 (52.9%) out of 87 patients developed intraoperative dysglycemia. 31.8% of all intraoperative BG measurements were detected outside the target range. Diabetes [OR 9.263 (95% CI 2.492, 34.433); p=0.001] and duration of surgery [OR 1.005 (1.000, 1.010); p=0.036] were independently associated with the development of intraoperative dysglycemia. Patients who experienced intraoperative dysglycemia had significantly elevated postoperative mean (p<0.001) and maximum BG levels (p=0.001). Length of ICU (p=0.007) as well as hospital stay (p=0.012) were longer in patients with dysglycemia. CONCLUSIONS? Diabetes and duration of surgery were confirmed as independent risk factors for intraoperative dysglycemia, which was associated with adverse outcome. These patients, therefore, might require intensified glycemic control. Increased awareness and management of intraoperative dysglycemia is warranted.

SUBMITTER: Knaak C

PROVIDER: S-EPMC6566747 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Risk Factors of Intraoperative Dysglycemia in Elderly Surgical Patients.

Knaak Cornelia C Wollersheim Tobias T Mörgeli Rudolf R Spies Claudia C Vorderwülbecke Gerald G Windmann Victoria V Kuenz Sophia S Kurpanik Maryam M Lachmann Gunnar G

International journal of medical sciences 20190510 5

BACKGROUNDː Dysglycemia is associated with adverse outcome including increased morbidity and mortality in surgical patients. Acute insulin resistance due to the surgical stress response is seen as a major cause of so-called stress hyperglycemia. However, understanding of factors determining blood glucose (BG) during surgery is limited. Therefore, we investigated risk factors contributing to intraoperative dysglycemia. METHODSː In this subgroup investigation of the BIOCOG study, we analyzed 87 pa ...[more]

PMID: 31217734

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Project description:ImportanceSurgical site infection (SSI) complicates 2-5% of surgeries in the United States. Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis, and SSIs are responsible for increased morbidity, mortality, and economic burden associated with surgery. Staphylococcus aureus (S. aureus) is a commonly-isolated organism for SSI, and methicillin-resistant S. aureus SSI incidence is increasing globally.ObjectiveThe objective of this systematic review was to characterize risk factors for SSI within observational studies describing incidence of SSI in a real-world setting.Evidence reviewAn initial search identified 328 titles published in 2002-2012; 57 were identified as relevant for data extraction. Extracted information included study design and methodology, reported cumulative incidence and post-surgical time until onset of SSI, and odds ratios and associated variability for all factors considered in univariate and/or multivariable analyses.FindingsMedian SSI incidence was 3.7%, ranging from 0.1% to 50.4%. Incidence of overall SSI and S. aureus SSI were both highest in tumor-related and transplant surgeries. Median time until SSI onset was 17.0 days, with longer time-to-onset for orthopedic and transplant surgeries. Risk factors consistently identified as associated with SSI included co-morbidities, advanced age, risk indices, patient frailty, and surgery complexity. Thirteen studies considered diabetes as a risk factor in multivariable analysis; 85% found a significant association with SSI, with odds ratios ranging from 1.5-24.3. Longer surgeries were associated with increased SSI risk, with a median odds ratio of 2.3 across 11 studies reporting significant results.Conclusions and relevanceIn a broad review of published literature, risk factors for SSI were characterized as describing reduced fitness, patient frailty, surgery duration, and complexity. Recognition of risk factors frequently associated with SSI allows for identification of such patients with the greatest need for optimal preventive measures to be identified and pre-treatment prior to surgery.

Project description:BackgroundPostoperative delirium (POD) is a common complication of major surgery and is associated with fortified morbidity, mortality, and long-term cognitive dysfunction. This study sought to evaluate the incidence and risk factors of delirium in elderly (aged ≥65 years) patients who underwent coronary artery bypass grafting (CABG).MethodsWe performed a retrospective cohort analysis. The clinical data of 1,426 elderly patients who underwent CABG at our hospital from October 2018 to October 2020 were collected and analyzed. Delirium was defined as any positive Confusion Assessment Method for Intensive Care Unit examination following surgery during the intensive care unit (ICU) stay. Risk factors for POD were authenticated via univariate and multivariate logistic regression analyses. The intraoperative and postoperative factors were evaluated using a propensity score-matched regression analysis based on preoperative factors.ResultsA total of 39.3% (560 of 1,426) of elderly patients who underwent CABG were diagnosed with delirium. Based on the multivariate analysis, age [odds ratio (OR) 1.013], long-term alcohol consumption (OR 2.026), diabetes (OR 1.51), stroke (OR 1.41), and extracardiac arteriopathy (OR 1.61) were found to be independent predictors of post-cardiac surgery delirium. Conversely, high-density lipoprotein cholesterol levels (HDL-C) ≥1.0 mmol/L (OR 0.71) was found to be a protective factor. Among the intraoperative and postoperative factors evaluated, only a prolonged ICU stay (≥48 h; OR 1.62) was identified as a risk factor for developing delirium in the propensity-score matched analysis, after adjusting for potential confounding variables and selection bias. In contrast to the earlier analysis, the multivariate logistic regression further revealed that peri-procedural myocardial infarction and postoperative arterial oxygen partial pressures were not significantly associated with POD.ConclusionsThe incidence of POD in elderly patients undergoing CABG was high. Factors such as older age, long-term alcohol consumption, diabetes, stroke, and extracardiac arteriopathy were independent risk factors for POD in these patients. In relation to the intraoperative and postoperative factors, after adjusting for preoperative confounding factors, only a prolonged ICU stay was identified as a risk factor for POD. Additionally, high levels of HDL-C may be beneficial in reducing the incidence of delirium.

Project description:BackgroundMost patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for managing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction.MethodsThis prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 ( http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to "Endoscopic Group (EG)" or "Surgical Group (SG)" via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention.ResultsSample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postoperative complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation.ConclusionEndoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus).

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Risk Factors of Intraoperative Dysglycemia in Elderly Surgical Patients.

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Risk Factors of Intraoperative Dysglycemia in Elderly Surgical Patients.

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