Validity of Glucose Measurement Methods During Surgery: A Systematic Review

Intraoperative hyperglycemia is associated with adverse patient outcomes and there are major quality gaps in intraoperative glucose measurement and management. It is unclear how anesthesiologists can accurately and feasibly measure glucose values during surgery. Our purpose in this systematic review was to describe the current literature describing the precision and accuracy of intraoperative glucose measurement to inform clinical decision-making for anaesthesiologists. A systematic search strategy identified English-language studies that compared 2 or more methods to measure a blood glucose value during surgery for adult, nonpregnant patients. MEDLINE, PubMed, Embase, and CINAHL were searched from inception until 2024. A grey literature search and hand searching of reference lists for included articles was also completed. Abstracts and full text were screened and then extracted in duplicate by study team members. Of 8,691 unique studies identified, 23 studies were included in the analysis (1,258 total patients, 4,071 pairs of glucose measurements). There was important heterogeneity between these studies with respect to the blood source, blood fraction, comparator measurement method, reference measurement method, and statistical analysis used. This heterogeneity precluded meta-analysis of results. Hypoglycemia was rare (9 of 1,992 measurements, 0.45%). Most studies did not use international accuracy standards to determine whether differences between their comparator measurement method and reference measurement method were clinically acceptable. The optimal method to measure intraoperative glucose is not known. In the meantime, anesthesiologists should consider the characteristics of existing glucose measurement methods when selecting a method for their settings and patients.