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Postoperative Hyperglycemia Increases Death Rate for PAD Patients

Hospitals usually are on the lookout for hyperglycemia in post-surgical patients with diabetes. A new study notes, however, that high blood sugar can be a serious problem even for post-surgical patients without a diabetes diagnosis.

The report in the Journal of Vascular Surgery points out that hyperglycemia causes complications, increased hospitalizations, and even death in peripheral artery disease (PAD) patients after surgery.

The University of Missouri School of Medicine-led study team tapped into Cerner Health Facts database to review 3,586 patient cases, which represented 67 urban hospitals.

Pointing out that PAD involves plaque buildup inside the arteries of the legs, lead author Todd Vogel, MD, associate professor and chief of the Division of Vascular Surgery at the MU School of Medicine, pointed out, "This buildup blocks blood flow to the lower extremities, and usually requires surgical intervention. Patients with PAD often have additional health concerns, such as diabetes. Our study looked at how common hyperglycemia is following surgery for PAD and how it affects post-surgical outcomes."

In fact, study results found that 20% of patients undergoing vascular procedures ended up with postoperative hyperglycemia. While no difference was determined as to hospital readmission, the condition led to increased infection rates and hospital stays, even in patients who did not have diabetes.

The research revealed that patients with postoperative hyperglycemia experienced longer hospital stays; on average, 6.9 vs 5.1 days. They also posted higher Charlson Comorbidity Index scores (3.4 vs. 2.5) and elevated infection rates (23% vs. 14%). Not only did these patients have more comorbidities, but their complications were more acute compared to patients with optimal glucose control, study authors note, and include fluid and electrolyte disorders, acute renal failure, postoperative respiratory complications, as well as more chronic problems such as anemia, chronic heart disease and chronic kidney disease, and diabetes.

The study team calculated that patients with postoperative hyperglycemia have 8.4 times the odds of dying in the hospital.

On the other hand, 30-day readmission was 10.9% for both groups, and no increase was documented for major amputations.

“Postprocedure glucose management may represent an important quality marker for improving outcomes after lower extremity vascular procedures,” the researchers concluded.

"I think of most interest was that diabetes alone was not associated with an increase in infection rates, length of stay, or mortality," Vogel added. "Although more research is needed, this suggests that post-procedure hyperglycemia is a significant risk factor for outcomes following lower extremity vascular procedures. Glucose management may represent an important method for improving outcomes following surgical interventions."