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Prospective Study of Postoperative Glycemic Control with a Standardized Insulin Infusion Protocol after Infrainguinal Bypass and Open Abdominal Aortic Aneurysm Repair
Andrea M. Steely1, Peter W. Callas2, Muriel H. Nathan1, Julie E. Adams1, Matthew J. Alef1, Andrew C. Stanley1, Georg Steinthorsson1, Daniel J. Bertges1.
1The University of Vermont Medical Center, Burlington, VT, USA, 2The University of Vermont College of Medicine, Burlington, VT, USA.
OBJECTIVE: The aim of this study was to examine the effect of moderate postoperative glycemic control in diabetic and non-diabetic patients undergoing infrainguinal bypass (INFRA) or open abdominal aortic aneurysm (OAAA) repair.
METHODS: In a single center prospective study, we investigated postoperative glycemic control using a standardized insulin infusion protocol after elective INFRA (N=53, 62%) and OAAA (N=33, 38%) between January 2013 and March 2015. The primary endpoint was optimal glycemic control, defined as having ≥85% of blood glucose values within the 80-180mg/dL target range. Suboptimal glycemic control was defined as <85% of blood glucose values within the blood glucose target range. Secondary endpoints included in-hospital and 30-day surgical site infection (SSI) rates and any adverse events.
RESULTS: Optimal glycemic control was achieved more commonly after OAAA than INFRA (85% vs. 64%, P=.04). Moderate hypoglycemia (<70 mg/dL) was observed in 32 (37%) patients while severe hypoglycemia (<50 mg/dL) was observed in 6 (7%) patients. SSI at 30-days was more common after INFRA (N=15, 29%) than OAAA (N=2, 6%) (P=.01). Patients who developed SSI had preoperative hemoglobin A1C values between 5.6% and 8.9% and had a mean glucose value of 125mg/dL. There was no difference between in-hospital SSI rates for patients with optimal glycemic control compared to those with suboptimal glycemic control (4.8% vs. 4.4%, P=.92). INFRA and OAAA patients with optimal glycemic control had 30-day SSI rates similar to those with suboptimal glycemic control (19% vs. 22%, P=.81). 29% of patients who developed SSI had poor glycemic control. The percentage of blood glucoses >250 mg/dL was similar for patients with and without SSI (3% vs. 2%, P=.36). Patients who had poor glycemic control were not more likely to suffer adverse events in the perioperative period (67% vs. 69%, P=.81).
CONCLUSIONS: Postoperative hyperglycemia is common after infrainguinal bypass and can be partially ameliorated with an insulin infusion protocol. Moderate glycemic control did not appear to reduce SSI rates, indicating other strategies are needed to reduce this frequent complication.
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