The association of postoperative glycemic control and lower extremity procedure outcomes

The effect of postoperative hyperglycemia in patients undergoing open and endovascular procedures on the lower extremities has not been fully characterized with regard to associated admission diagnoses, hospital complications, mortality, and 30-day readmission. This study evaluated the relationship of postoperative hyperglycemia on outcomes after lower extremity vascular procedures for peripheral artery disease.

Patients with peripheral artery disease admitted for elective lower extremity procedures between September 2008 and March 2014 were selected from the Cerner Health Facts (Cerner Corporation, Kansas City, Mo) database using International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis and procedure codes. Using χ² analysis, we evaluated the relationship of postoperative hyperglycemia (>180 mg/dL) with sociodemographic characteristics, acute and chronic diagnoses, infections, hospital length of stay (LOS), and 30-day readmission. An adjusted multivariable logistic model was used to examine the association of postoperative hyperglycemia with infection and LOS.

Of 3586 patients in the study, 2812 (78%) had optimal postoperative glucose control, and 774 (22%) had suboptimal glucose control (hyperglycemia). On average, patients with postoperative hyperglycemia experienced longer hospital stays (6.9 vs 5.1 days; P < .0001), higher Charlson Comorbidity Index scores (3.4 vs 2.5, P < .0001), higher rates of infection (23% vs 14%, P < .0001), more acute complications (ie, fluid and electrolyte disorders, acute renal failure, postoperative respiratory complications), and chronic problems (ie, anemia, chronic heart disease, chronic kidney disease, and diabetes) than patients with optimal glucose control. Overall 30-day readmission was 10.9% and was similar between the groups (10.9% for both; P = .93). Major amputations did not differ between groups (P = .21). After adjusting for other risk factors using multivariable logistic regression, patients with hyperglycemia have 1.3-times the odds to have an infectious complication compared with those with optimal glucose control (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06-1.69) and 1.7-times the odds to have a hospital LOS >10 days (OR, 1.69; 95% CI, 1.32-2.15). As well, patients with postoperative hyperglycemia have 8.4-times the odds of dying in the hospital (OR, 8.40; 95% CI, 3.95-17.9).

One in five patients undergoing vascular procedures had postoperative hyperglycemia. Postoperative hyperglycemia was associated with adverse events after lower extremity vascular procedures in patients with and without diabetes, including infection, increased hospital utilization, and mortality. No difference was found with respect to hospital readmission. Postprocedure glucose management may represent an important quality marker for improving outcomes after lower extremity vascular procedures.