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Early Postoperative Hyperglycemia Is Associated With Postoperative Complications After Pancreatoduodenectomy

Eshuis, Wietse J. MD*; Hermanides, Jeroen MD; van Dalen, Jan W.; van Samkar, Gan MD; Busch, Olivier R.C. MD, PhD*; van Gulik, Thomas M. MD, PhD*; DeVries, J. Hans MD, PhD; Hoekstra, Joost B.L. MD, PhD; Gouma, Dirk J. MD, PhD*

doi: 10.1097/SLA.0b013e31820b4bfc
Original Articles

Objective: To investigate the relation between perioperative hyperglycemia and complications after pancreatoduodenectomy.

Background: Perioperative hyperglycemia is associated with complications after various types of surgery. This relation was never investigated for pancreatoduodenectomy.

Methods: In a consecutive series of 330 patients undergoing pancreatoduodenectomy, glucose values were collected from the hospital information system during 3 periods: pre-, intra-, and early postoperative. The average glucose value per period was calculated for each patient and divided in duals according to the median group value. Odds ratios for complications were calculated for the upper versus lower dual, adjusted for age, sex, American Society of Anesthesiologists Classification, body mass index, diabetes mellitus, intraoperative blood transfusion, duration of surgery, intraoperative insulin administration, and octreotide use. The same procedures were carried out to assess the consequences of increased glucose variability, expressed by the standard deviation.

Results: Average glucose values were 135 (preoperative), 133 (intraoperative) and 142 mg/dL (early postoperative). Pre- and intraoperative glucose values were not associated with postoperative complications. Early postoperative hyperglycemia (≥140 mg/dL) was significantly associated with complications [odds ratio (OR) 2.9, 95% confidence interval (CI), 1.7–4.9]. Overall, high glucose variability was not significantly associated with postoperative complications, but early postoperative patients who had both high glucose values and high variability had an OR for complications of 3.6 (95% CI, 1.9–6.8) compared to the lower glucose dual.

Conclusions: Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy. High glucose variability may enhance this risk. Future research must demonstrate whether strict glucose control in the early postoperative period prevents complications after pancreatoduodenectomy.

The relation between perioperative hyperglycemia and complications after pancreatoduodenectomy was investigated in 330 patients. We found that early postoperative hyperglycemia is associated with postoperative complications. This potentially modifiable risk factor may be a valuable point of application for future clinical studies on the prevention of complications after pancreatoduodenectomy.

*From the Departments of Surgery.

Internal Medicine.

Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands.

Reprints: Dirk J. Gouma, MD, PhD Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. E-mail:

The study has received no form of commercial sponsorship.

None of the authors of the study has any form of financial support or commercial sponsorship to disclose.

After careful evaluation of your authorship criteria, we believe that all individuals listed are justifiably credited with authorship. Here, we provide an overview of each author's basic contribution.

W.J.E.: study design, data collection, statistical analysis, manuscript drafting. J.H.: study design, statistical analysis, manuscript drafting. J.W.D.: data collection, study design. G.S.: data collection, advisor of intraoperative and early postoperative glucose management. O.R.C.B. and T.M.G.: performed operations, advisor of reporting perioperative hospital course, assisted in interpretation of the data, manuscript editing. J.H.D.V.: study design, manuscript editing. J.B.L.H.: principal investigator, study design, manuscript editing. D.J.G.: principal investigator, performed operations, study design, principle editor of the manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.