Effect Of Glucose Metabolism Status On The Complications And Glycemic Change After Pancreatic Resection

Part 1 Effect of glucose metabolism status on the complications after pancreatic resectionObjective:To explore the relationship between glucose metabolism status and the complications after pancreatic resection.Methods:To address this issue, this study retrospectively reviewed all patients undergoing pancreatic resection between January,2005, and August,2015. These patients were categorized into three groups:the diabetes mellitus group, the impaired fasting glucose group, and the normal glycemic metabolism group. Records were reviewed for comorbidities, operative variables, and histologic parameters. The incidence of complications was assessed using standardized definitions.Results:The glucose metabolism status had no significantly impact on the incidence of pancreatic fistula, delayed gastric emptying and hemorrhage after pancreatic resection. And there was no absolute difference in morbidity and mortality between different groups. However, diabetes mellitus and impaired fasting glucose were associated with an increased probability of infectious complications, with odds ratios of 2.61 (95%CI:1.53-4.46) and 2.49 (95%CI:1.31-4.74).Conclusions:There was no significant effect of diabetes mellitus and impaired fasting glucose on the incidence of pancreatic fistula, delayed gastric emptying and hemorrhage after pancreatic resection. But diabetes mellitus and impaired fasting glucose were risk factors for postoperative infectious complication.Part 2 Effect of early postoperative hyperglycemia on the complications after pancreatic resectionObjective:To explore the relationship between early postoperative hyperglycemia on the complications after pancreatic resection.Methods:This study retrospectively reviewed 284 patients undergoing pancreatic resection with a detailed postoperative glycemic management. The postoperative glucose values were collected from the hospital record system. These patients were divided into two groups according to the average glucose of postoperative day 1. Records were reviewed for comorbidities, operative variables, and histologic parameters. The incidence of complications was assessed using standardized definitions.Results:The glycemic metabolism status had a significantly impact on the incidence of early postoperative hyperglycemia. And early postoperative hyperglycemia was not a risk factor for pancreatic fistula, delayed gastric emptying and hemorrhage after pancreatic resection. While, early postoperative hyperglycemia was associated with an increased probability of infectious complications, with odds ratios of 2.53 (95%CI:1.42-4.53). The blood glucose cut-off that predicted postoperative infectious complications occurrence was lOmmol/L.Conclusions:Early postoperative hyperglycemia was associated with an increased probability of postoperative infectious complications and length of hospital stay. Preoperative impaired fasting glucose and diabetes mellitus had higher risk of postoperative hyperglycemia, which indicated more attentions should be given to glycemic control in these patients with a glycemic goal of 10mmol/L.Part 3 Glycemic change after pancreatic resectionObjective:To explore factors associated with glycemic change after pancreatic resection.Methods:Among the patients undergoing pancreatic resection, the ones still alive were included in this study. A DM-focused telephone survey was administered for these patients. Data included diabetic status, date of diagnosis, and medical management were collected through the survey. Records were reviewed for comorbidities, operative variables, and histologic parameters.Results:In 19 preoperative diabetic patients,6 worsen diabetes mellitus were observed, while only two improved diabetes mellitus. There were 22 (15.0%) patients developed diabetes mellitus after pancreatic resection in the preoperative nondiabetic patients. Multivariate logistic analysis showed preoperative impaired fasting glucose and chronic pancreatitis as risk factors for the development of postoperative diabetes.Conclusions:Preoperative impaired fasting glucose was associated with the development of diabetes mellitus after pancreatic resection. Active follow-up for patients with preoperative impaired fasting glucose should be done to ensure better glycemic control of them.