Postoperative Blood Glucose Spikes Predict Morbidity After Pancreatoduodenectomy

Pancreatoduodenectomy and distal pancreatectomy are standard surgical treatments for pancreatic tumors but are associated with significant postoperative morbidity. A blood glucose spike (BGS), defined as a rapid, transient rise in glucose levels, may impair vascular function and affect recovery. We aimed to characterize postoperative BGS using continuous glucose monitoring and evaluate associated complications.

This prospective observational study included 46 patients who underwent pancreatoduodenectomy (n = 34) or distal pancreatectomy (n = 12) between December 2017 and January 2023 at two centers. Glucose levels were continuously monitored for up to 14 days postoperatively using continuous glucose monitoring. BGS was defined as a glucose rise of > 7.8 mmol/L (140 mg/dL), followed by a drop to < 7.8 mmol/L within 2 h. Complications were graded using the Clavien-Dindo classification, with Grade ≥ II considered clinically significant. Multivariate logistic regression identified predictors of morbidity.

Patients who underwent pancreatoduodenectomy had lower preoperative albumin levels, prognostic nutritional index values, and more frequent nocturnal BGS (p = 0.009) than did those who underwent distal pancreatectomy. Mean, maximum, and minimum glucose levels did not differ between groups. Postprandial BGS occurred in all patients after distal pancreatectomy. BGS was associated with complications (p < 0.001) and was the strongest predictor of postoperative morbidity (p = 0.023) in those who underwent pancreatoduodenectomy.

Postoperative BGS is common after pancreatectomy and strongly predicts morbidity after pancreatoduodenectomy. Continuous glucose monitoring-based detection and management of BGS may reduce postoperative complications.