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A prospective observational prevalence study of elevated HbA1c among elective surgical patients.

ABSTRACT: Type 2 Diabetes Mellitus (DM) is a chronic disease with high prevalence worldwide. Using glycated haemoglobin (HbA1c) as a surrogate for potential pre-DM and DM conditions, our primary objective was to determine the HbA1c epidemiology in non-cardiac elective surgical patients in Singapore. Our secondary aim was to identify risk factors associated with elevated HbA1c. We conducted a prospective, observational single-centre study in adult patients. HbA1c screening was performed. Patient demographics and comorbidities were recorded. Patients were divided into those with HbA1C???6.0% and HbA1C???6.1%. Regression analyses were performed to identify associated factors. Subgroup analysis was performed comparing patients with HbA1C???6.1% and HbA1C???8.0%. Of the 875 patients recruited, 182 (20.8%) had HbA1c???6.1%, of which 32 (3.7%) had HbA1c???8%. HbA1C???6.1% was associated with Indian ethnicity [1.07 (1.01-1.13), p?=?0.023], BMI?>?27.5 [1.07 (1.02-1.11), p?=?0.002], higher preoperative random serum glucose [1.03 (1.02-1.04), p??60 years [0.96 (0.93-0.99), p?=?0.017]. The prevalence of elevated HbA1c is high among the surgical population. Targeted preoperative HbA1c screening for at-risk elective surgical patients reduces cost, allowing focused use of healthcare resources.

SUBMITTER: Teo LM

PROVIDER: S-EPMC7642441 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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A prospective observational prevalence study of elevated HbA1c among elective surgical patients.

Teo L M LM Lim W Y WY Ke Y Y Sia I K L IKL Gui C H CH Abdullah H R HR

Scientific reports 20201104 1

Type 2 Diabetes Mellitus (DM) is a chronic disease with high prevalence worldwide. Using glycated haemoglobin (HbA1c) as a surrogate for potential pre-DM and DM conditions, our primary objective was to determine the HbA1c epidemiology in non-cardiac elective surgical patients in Singapore. Our secondary aim was to identify risk factors associated with elevated HbA1c. We conducted a prospective, observational single-centre study in adult patients. HbA1c screening was performed. Patient demographi ...[more]

PMID: 33149252

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Project description:BackgroundPreoperative assessment is crucial to prevent the risk of complications of surgical operations and is usually focused on functional capacity. The increasing availability of wearable devices (smartwatches, trackers, rings, etc) can provide less intrusive assessment methods, reduce costs, and improve accuracy.ObjectiveThe aim of this study was to present and evaluate the possibility of using commercial smartwatch data, such as those retrieved from the Fitbit Inspire 2 device, to assess functional capacity before elective surgery and correlate such data with the current gold standard measure, the 6-Minute Walk Test (6MWT) distance.MethodsDuring the hospital visit, patients were evaluated in terms of functional capacity using the 6MWT. Patients were asked to wear the Fitbit Inspire 2 for 7 days (with flexibility of -2 to +2 days) after the hospital visit, before their surgical operation. Resting heart rate and daily steps data were retrieved directly from the smartwatch. Feature engineering techniques allowed the extraction of heart rate over steps (HROS) and a modified version of Non-Exercise Testing Cardiorespiratory Fitness. All measures were correlated with 6MWT.ResultsIn total, 31 patients were enrolled in the study (n=22, 71% men; n=9, 29% women; mean age 76.06, SD 4.75 years). Data were collected between June 2021 and May 2022. The parameter that correlated best with the 6MWT was the Non-Exercise Testing Cardiorespiratory Fitness index (r=0.68; P<.001). The average resting heart rate over the whole acquisition period for each participant had r=-0.39 (P=.03), even if some patients did not wear the device at night. The correlation of the 6MWT distance with the HROS evaluated at 1% quantile was significant, with Pearson coefficient of -0.39 (P=.04). Fitbit step count had a fair correlation of 0.59 with 6MWT (P<.001).ConclusionsOur study is a promising starting point for the adoption of wearable technology in the evaluation of functional capacity of patients, which was strongly correlated with the gold standard. The study also identified limitations in the availability of metrics, variability of devices, accuracy and quality of data, and accessibility as crucial areas of focus for future studies.

Project description:BackgroundHypoxemia is one of the feared critical events intraoperatively and postoperatively. Undetected postoperative oxygen hypoxemia may lead to pulmonary hypertension, hyperkalemia, respiratory and cardiac failure even brain ischemia, and lastly, it may end up with multiorgan failure. The main purpose of this study was to determine the incidence and associated factors for postoperative hypoxemia among elective surgical patients received anesthesia in Dessie Comprehensive Specialized Hospital.MethodsProspective observational study was conducted in Dessie comprehensive Specialized Hospital from March to June 2021. The study included elective surgical patients. The data was collected with structured questionnaires, and direct measurement of oxygen saturation with pulse oximetry. Statistical analysis was done by using the Statistical Package of Social Science version 23.ResultsA total of 298 patients enrolled with a response rate of 94% in the study. Among the study participants, 167 (56%) were females and 131 (44%) were males. The Mean (±Standard Deviation) age was 37.62 ± 15.75 years. The incidence of hypoxemia was 24.5% (95% of Confidence Interval 19.34, 30.62) among 298 postoperative patients. Associated factors with postoperative hypoxemia were age greater than 55 years, preoperative saturation below 95%, type of anesthesia, postoperative pain score, and postoperative muscular strength, The patient age below 55 years had 84% less likely to develop hypoxemic episodes postoperatively when we compare age above 55-year-old. A patient who received general anesthesia had a chance of developing hypoxia eight times than those who received regional anesthesia. A patient who can keep grip for 15 s had 60% less likely to develop hypoxemia than those who can keep a grip for 15 s postoperatively.ConclusionThis study showed that there was a high incidence of postoperative hypoxemia among elective surgical patients in the study area. The high-risk patients should be identified and postoperative oxygen therapy should be initiated for those high-risk patients.

Project description:BackgroundA low plasma glutamine level at the time of acute admission to the intensive care unit (ICU) is an independent predictor of an unfavourable outcome in critically ill patients. The primary objective of this study was to determine whether there are differences in plasma glutamine levels upon non-elective or elective ICU admission. The secondary objective was to compare glutamine levels over time, and to determine correlations between glutamine levels and the severity of illness and presence of infection in ICU patients.MethodsWe performed a single-centre observational study in a closed-format, 22-bed, mixed ICU. Plasma glutamine levels were measured at admission and every morning at 6.00 a.m. during the ICU stay. We aimed to include at least 80 patients per group. The study was approved by the local Medical Ethics Committee.ResultsIn 88 patients after elective surgery, the median plasma glutamine level at admission was significantly higher compared with that in 90 non-elective patients (0.43 mmol/l [0.33-0.55 mmol/l] versus 0.25 mmol/l [0.09-0.37 mmol/l], P = 0.001). During the ICU stay, plasma glutamine levels remained significantly higher in elective patients than in non-elective patients. There was a significant correlation between the APACHE IV score and glutamine levels (R = 0.52, P < 0.001). Moreover, backward linear regression analysis showed that this correlation was independently associated with the APACHE IV score and the presence of infection, but not with the type of admission.ConclusionsPlasma glutamine levels are significantly lower after non-elective admission compared with elective admission to the ICU. A considerable amount of elective and non-elective patients have decreased plasma glutamine levels, but this is not independently associated with the type of admission. In contrast to previous studies, we found that plasma glutamine levels were determined by the severity of illness and the presence of an infection.Trial registrationClinicalTrials.gov, number NCT02310035.

Project description:BackgroundPostoperative delirium (POD) is common and has negative effects on elderly patients. There is a critical need to identify patients at high risk of POD so that providers can better offer targeted interventions in the preoperative and intraoperative periods. We aimed to characterize the prevalence of preoperative anxiety and investigate whether preoperative anxiety predicted the onset of POD in elderly patients undergoing elective orthopedic surgery.MethodsWe conducted a prospective observational cohort study of elderly patients (aged 65 years or older) undergoing elective orthopedic surgery. Preoperative anxiety was assessed using the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), with clinically significant values defined as HADS-A>7. POD was diagnosed according to the Confusion Assessment Method (CAM) criteria on the 5 postoperative days. To determine the independent risk factors for POD, multivariable logistic regression was conducted, including those variables with a p-value <0.05 at univariate analysis.ResultsThere were 263 patients included in the study. Seventy-three (27.8%) patients were diagnosed to be POD. Median duration of delirium was 2 days. Forty (15.2%) patients were assessed to experience preoperative anxiety. The occurrence of preoperative anxiety in total hip arthroplasty (THA), proximal femoral nail antirotation (PFNA), and total knee arthroplasty (TKA) was 12.5%, 16.1%, and 19.5%, respectively. Based on multivariable analysis, only age (odds ratio [OR]= 1.099, 95% Confidence Interval [CI]: 1.013-1.192; P=0.023), Mini Mental State Examination (MMSE) (OR= 0.603, 95% CI: 0.432-0.842; P=0.003) and preoperative anxiety (OR= 3.119, 95% CI: 1.144-8.500; P=0.026) were independently associated with POD.ConclusionIn conclusion, the current study reveals that preoperative anxiety helps to predict the risk of POD in elderly patients undergoing elective orthopedic surgery. Relieving preoperative anxiety could be a new target for preventive interventions to reduce POD.

Project description:BackgroundDelayed gastric emptying and the resultant "full stomach" is the most important risk factor for perioperative pulmonary aspiration. Using point-of-care gastric sonography, we aimed to investigate the prevalence of full stomach and its risk factors in elective surgical patients with type 2 diabetes.MethodsType 2 diabetic and non-diabetic elective surgical patients were included from July 2017 to April 2018 in a 1:1 ratio. The study was retrospectively registered at July 2017, after enrollment of the first participant. Gastric ultrasound was performed 2 h after ingesting clear fluid or 6 h after a light meal. Full stomach was defined by the presence of gastric content in both semi-recumbent and right lateral decubitus positions. For patients with full or intermediate stomach, consecutive ultrasound scan was performed until empty stomach was detected. Logistic regression analyses were used to identify risk factors associated with full stomach.ResultsFifty-two type 2 diabetic and fifty non-diabetic patients were analyzed. The prevalence of full stomach was 48.1% (25/52) in diabetic patients, with 44.0% for 2-h fast after clear fluid and 51.9% for 6-h fast after a light meal, significantly higher than 8% (4/50) in non-diabetic patients (P = 0.000). The average time to empty stomach in diabetic patients was 146.50 ± 40.91 mins for clear liquid and 426.50 ± 45.25 mins for light meal, respectively. Further analysis indicated that presence of diabetes-related eye disease was an independent risk factor of full stomach in diabetic patients (OR = 4.83, P = 0.010).ConclusionsAlmost half of type 2 diabetic patients have a full stomach following the current preoperative fasting guideline. Preoperative ultrasound assessment of gastric content in type 2 diabetic patients is suggested, especially for those with diabetes -related eye disease.Trial registrationThe trial was registered at www.clinicaltrials.gov with registration number NCT03217630 . Retrospectively registered on 14th July 2017.

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A prospective observational prevalence study of elevated HbA1c among elective surgical patients.

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A prospective observational prevalence study of elevated HbA1c among elective surgical patients.

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