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Annals of Surgery Journal Club
Interactive resource for surgery residents and surgeons to discuss and critically evaluate articles published in Annals of Surgery selected by a monthly guest expert who will review an article each month, offer questions and respond to reader's comments.
Wednesday, August 06, 2014
August 2014 Journal Club
Moderator: Grant V. Bochicchio, MD
 
 
Summary:

This study was a retrospective database review of  2447 non-diabetic postoperative colorectal surgical patients in which 16,407 glucose measurements were obtained over a 2 year period.  Nondiabetic patients were identified as those without a preoperative diagnosis of diabetes and/or based on HbA1C levels. The association between any elevated postoperative random glucose value (hyperglycemia: >125 mg/dL) and level of elevation (>125 mg/dL or >200 mg/dL) within 72 hours of surgery and 30-day mortality and infectious and noninfectious complications was assessed.   Significant associations were found between postoperative hyperglycemia

and the length of operation, extent of blood loss, and transfusion requirements. Hyperglycemia (mild or severe) was associated with increased rates of infectious complications (superficial

and deep SSI, urinary tract infections), sepsis, acute renal failure, reintubation and a greater LOS. The risk for complications increased with an increasing level of postoperative glycemia. Reoperations were twice as frequent for patients with severe hyperglycemia

when compared with those with normoglycemia (7.3% vs 3.1%, P = 0.006). Although rare, postoperative mortality was significantly associated with postoperative glycemia, with only 1 (0.12%) patient with normoglycemia having died during the first 30 postoperative days as

compared with 4 (1.2%) of the patients who had 1 or more values of severe postoperative hyperglycemia.

 

Questions:

1.       Hyperglycemia in this article was defined as a glucose level greater than 125 mg/dl

a.   During the entire postoperative stay

b.   Within 24 hours of surgery

c.   Within the first 48 hours post surgery

d.   Level obtained prior to infection.

 

2.      True OR False

 

Steroid use was associated with a greater risk of reoperation and length of stay in these non-diabetic colorectal surgical patients.

 

3.      True or False

 

A single postoperative episode of elevated glucose in this study was associated with a greater risk of morbidity and mortality.

 

4.       Tight glycemic control

a.   Was associated with a decrease in surgical site infections

b.   Decreased mortality

c.    a & b

d.    None of the above

 

Answers to these questions can be found in "From the Editorial Office".

 

Please feel free to comment on any or all of the questions above. We look forward to hearing from you, the Annals readers. This article can be accessed for free.

 

 

 

 

 

 

About the Author

Dr. David T Efron
Dr. Efron is an Associate Professor of Surgery, Anesthesiology & Critical Care Medicine and Emergency Medicine at the Johns Hopkins School of Medicine. He is the Director of Trauma and Chief of the Division of Acute Care Surgery (encompassing Trauma, Emergency Surgery and Surgical Critical Care) in The Johns Hopkins Hospital Department of Surgery. He is currently the Vice-Chair of the Maryland State Committee on Trauma. Dr. Efron’s current research interests are within the realm of regulation of inflammatory mediators of septic and post-injury states, particularly focusing on the role that statins play in this milieu. Dr. Efron carries additional interest in traumatic injury from interpersonal violence, measures of violence intensity, and trauma recidivism with an eye to prevention strategies.

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