Effects Of Intraoperatuve Blood Glucose On In-hospital Complications After Carotid Endarterectomy

Objective Perioperative hyperglycemia is associated with adverse outcomes after cardiac and noncardiac surgery.However,whether intraoperative blood glucose concentration affects in-hospital prognosis of patients after carotid endarterectomy(CEA)remains unclear.The purpose of this study was to investigate the effect of intraoperative hyperglycemia and blood glucose variability(GV)on the in-hospital complications after CEA under general anesthesia.Methods The analysis of retrospectively collected data included 265 cases who underwent CEA between 2015 and January 2020 at the Affiliated Drum Tower Hospital of Nanjing University Medical School.According to the blood gas analysis during the operation,the highest blood glucose value,average blood glucose level and GV were obtained and calculated.It is defined as hyperglycemia when blood glucose value is greater than 10mmol/L at any time during operation.According to this standard,patients were divided into hyperglycemic group(>10 mmol/L)and non-hyperglycemic group(≤10 mmol/L).Standard deviation(SD)and coefficient of variation(CV)of intraoperative blood glucose were used to calculate GV.The changed trend of intraoperative blood glucose level with time were analyzed using ANOVA.After adjusting for potential confounding factors,multiple logistic regression models evaluated the relationship between intraoperative blood glucose concentration greater than 10 mmol/L,intraoperative GV and adverse outcomes during hospital stay.Another statistical model was used to predict the potential risk factors of elevated blood glucose during CEA.Results In this study,41 patients(15.5%)had hyperglycemia during CEA,among which35 patients(85.4%)had diabetes mellitus(DM).The mean values,maximum values,SD and CV of intraoperative blood glucose in the hyperglycemia group were significantly higher than those in non-hyperglycemia group(P<0.001).In addition,the preoperative and postoperative blood glucose level in the hyperglycemia group were significantly higher than those in non-hyperglycemia group(P<0.001).The blood glucose values at three time points of anesthesia induction,carotid occlusion and tracheal extubation in hyperglycemia group were significantly higher than those in non-hyperglycemia group(P<0.05).The blood glucose of hyperglycemia group increased significantly with the operation progress,while that of non-hyperglycemia group was relatively stable.After adjusting for the influence of confounding factors,DM,preoperative blood glucose level and blood glucose level in anesthesia-induced period were independent risk factors for predicting elevated blood glucose during CEA(P<0.05).Intraoperative blood glucose greater than 10 mmol/L was associated with in-hospital myocardial infarction morbidity and overall morbidity after CEA(P<0.05).Conclusion DM,preoperative hyperglycemia and induced hyperglycemia can increase the risk of intraoperative hyperglycemia.Hyperglycemia during operation is closely related to the increased incidence of in-hospital myocardial infarction and the overall morbidity after CEA.