Introduction: The relationship between poor outcome and uncontrolled blood glucose level is evident in surgical patients. The optimal range of blood sugar to be maintained in the perioperative period is not well defined.
Aim: Our aim in this study was to see if the incidence of postoperative complications in preoperatively poorly controlled patients is comparable to that of patients who are well controlled.
Methods: 100 consecutive patients (60 well controlled and 40 poorly controlled) admitted for elective major surgery were recruited. Patients who met the inclusion criteria were stratified into two groups- relatively “well” controlled preoperative glucose (fasting blood sugar FBS < 10mmol/L) and “poorly” controlled preoperative glucose (FBS 10mmol/L). Data collection included baseline demographics, pre-morbid comorbidities, type and duration of diabetes, treatment, anaesthesia technique, and preoperative glycemic control. During the postoperative period blood glucose control and incidence of complications such as surgical wound infection, impaired wound healing, metabolic derangements, reoperation, sepsis hospital stay and death were documented.
Results: Mean age was 53.211 in the well controlled group and 55.311.9 in the poorly controlled group. There was no difference in pre-operative co-morbidities between the two groups. The blood sugar levels in the first two postoperative days were significantly higher in the poorly controlled group. There was a significant increase in the rate of surgical wound infection in the poorly controlled group (22.5% vs 5.0%) as compared to well controlled group (p=0.008). Similarly the poorly controlled group had higher incidence of reoperation (p=0.01) and increased incidence of hypoglycemic episodes in the postoperative period (12.5% vs 1.7% p=0.02). The postoperative hospital stay was significantly prolonged in the poorly controlled group (8.4 days 4.8 vs 5.9 days 3.4 p=0.002).
Conclusion: This study proves that good preoperative control of blood sugars (FBS < 10mmol/L) is necessary for a good post-operative outcome.