Hyperglycemia and ambulatory surgery

Abstract

Background: Perioperative hyperglycemia is associated with postoperative complications after major surgery. However, more than 50% of surgical procedures are performed in an ambulatory setting, where glucose is not routinely measured. The objectives of this study were to investigate the change in capillary glucose during ambulatory surgery, to identify patients at risk for perioperative increasing glucose and to evaluate whether hyperglycemia predisposes for complications after ambulatory surgery.

Methods: In this prospective multicenter cohort study, adult patients planned for ambulatory surgery, were included and capillary glucose was measured 1 hour before and 1 hour after surgery. Patients were contacted 90 days after surgery to determine the occurrence of postoperative complications.

Results: Nine hundred and nine patients were included, 48 (5.3%) patients had diabetes mellitus (DM). Overall median glucose increased from 5.4 mmol L-1 preoperatively to 5.6 mmol L-1 postoperatively (P<0.001). Hyperglycemia, glucose ≥7.8 mmol L-1, occurred in 8.8% of the patients. Dexamethasone administration (given in 406 [44.7%] patients) was a risk factor for glucose increase (P<0.001). Hyperglycemia was not a risk factor for postoperative complications (OR 1.19, 95%CI 0.57-2.48, P=0.646). However, prediagnosed DM was a risk factor for postoperative complications, independent of hyperglycemia (OR 2.56, 95%CI 1.10-5.97, P=0.030).

Conclusion: Minor ambulatory surgery is not associated with a clinically relevant increase in glucose. The very small glucose increase we observed could be attributed to the administration of dexamethasone for PONV prophylaxis. Hyperglycemia during ambulatory surgery is not associated with complications after discharge.