Effects of glucose-insulin infusion during major oral and maxillofacial surgery on postoperative complications and outcomes

Abstract

Background: Secretion of hormones, which antagonize the action of insulin, is facilitated in response to surgery, and acute resistance to the action of insulin develops. Our aim is to elucidate the effects of intraoperative glycemic control by glucose-insulin (GI) infusion on postoperative complications and outcomes in major oral and maxillofacial surgery.

Findings: Thirty patients aged ≥ 60 years undergoing a radical operation of oral malignant tumors with tissue reconstruction (≥ 8 h) were analyzed. In the GI group, regular insulin was continuously applied with glucose-added acetate Ringer's solution (5-10 g glucose per 500 mL). Blood glucose was adjusted within the target concentration of 80-120 mg/dL. In the control group, combination of acetate Ringer's solution containing 1% (W/V) glucose and lactate Ringer's solution, which contains no glucose, was employed. Perioperative clinical parameters, incidence of hypoalbuminemia, and postoperative complications, i.e., surgical site infection, necrosis of a reconstructed flap, bacteremia, hypotension, or pneumonia, were compared. Both serum total protein and albumin concentrations (postoperative day 1 [Day1]) were higher in the GI group. The mean infusion rate of glucose during surgery (mg/kg/h) was independently associated with the decrease in both serum total protein and albumin concentrations from the control to Day1. No difference was found between the groups in the incidence of postoperative complications and the days required until discharge, except less incidence of hypoalbuminemia in the GI group.

Conclusions: Application of additional glucose during major oral and maxillofacial surgery preserved serum albumin concentration. However, it did not lead to less postoperative complications and less days until discharge.

Keywords: Hypoalbuminemia; Inflammation; Postoperative complication; Surgical diabetes.

Fig. 1

Time course of CRP concentration (a) and body temperature (b) in the control group (closed circles) and the GI group (open circles). Data are expressed as mean ± SD. Day postoperative day, CRP C-reactive protein, GI glucose-insulin. No significant difference was found between the groups

Fig. 2

Time course of total protein (a) and serum albumin (b) concentrations and relationships between the mean infusion rate of glucose during surgery and TP concentrations at Day1 (c) and serum albumin concentrations at Day1 (d) in the control group (closed circles) and the GI group (open circles). Data are expressed as mean ± SD. Day postoperative day, TP total protein, GI glucose-insulin. ‡P < 0.05 compared between the groups