Pre-operative Glucose Predicts Post-Operative Complications Following Complex Abdominal Wall Reconstruction
Troy Marxen, BS, Shannon Su, BS, Ciara Brown, MD, Heather Faulkner, MD MPH, Albert Losken, MD.
Emory University, Atlanta, GA, USA.
Purpose: The primary aim of this study was to determine whether preoperative hyperglycemia predicted surgical outcome after complex abdominal wall reconstruction (CAWR). The secondary aim was to establish glucose thresholds to assist with surgical risk stratification.Methods: All patients that underwent CAWR by the senior author at a single institution from 2002-2021 were retrospectively reviewed. Patients were stratified into four groups based on pre-operative blood glucose: <100 mg/dl (n=184), 100-140 mg/dl (n=207), 140-180 mg/dl (n=41), and > 180 mg/dl (n=16). Patient demographics, risk factors, surgical techniques, complications, and outcomes were recorded and compared.Results: The study cohort was comprised of 478 patients. Mean age was 53.9 ± 12.3 years. Mean body mass index (BMI) was 32.1 ± 7.8. Higher age (p=0.0085), higher BMI (p=0.0005), the presence of diabetes (<0.0001), and hypertension (0.0004) were significantly associated with higher glucose. Overall complication rates ranged from 26% (glucose <100mg/dL) to 94% (glucose >180 mg/dL) while recurrence rates ranged from 10% (glucose <100 mg/dL) to 37% (glucose 140-180 mg/dL). Multivariate logistic regression analysis revealed pre-operative glucose to have a significant, independent effect on overall complication rate (p<0.0001), major complication rate (p<0.0001), and recurrence rate (p<0.0031).Conclusion: Pre-operative hyperglycemia is an important predictor of post-operative complications and recurrence following CAWR. Point of care glucose levels are routinely gathered prior to surgery and may help to establish thresholds for which elective CAWR might be deferred. Strategies to lower pre-operative glucose should be part of an optimization protocol for improving outcomes.
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