Association Between Preoperative Blood Glucose Level And PPCs For Patients Undergoing Thoracic Surgery

Background:The current situation of diabetes in China is serious:the prevalence rate is increasing year by year,the awareness rate,treatment rate and control rate are low,and the management and treatment of diabetes are facing great challenges.As many as 50%of diabetic patients will undergo surgery at least once in their lifetime,and perioperative glucose abnormalities(including hyperglycemia,hypoglycemia,and glucose variability)occur.Postoperative pulmonary complications(PPCs)cover almost all complications affecting the respiratory system after anesthesia and surgery,including pulmonary infections,pulmonary atelectasis,respiratory failure,pleural effusion,pneumothorax,bronchospasm,and pulmonary aspiration,which are variously defined,occur at high and unpredictable rates,and can reach 19%-59%in thoracic surgery,significantly increasing the length of postoperative hospitalization,increasing hospital costs,and decreasing patient satisfaction.Preoperative blood glucose levels may be associated with perioperative complications and poor prognosis,including infection,reoperation,prolonged length of stay,and death,and have significant and unique adverse effects on the perioperative cardiovascular,neurological,respiratory,urinary,and digestive systems.Blood glucose levels are a modifiable preoperative factor,and there is a lack of research on the relationship between preoperative blood glucose levels and this composite outcome of PPCs in patients undergoing thoracic surgery.Therefore,the aim of this study was to investigate the relationship between preoperative blood glucose levels and PPCs in patients undergoing thoracic surgery.Methods:This study is a retrospective cohort analysis of adult patients undergoing thoracic surgery at Nanfang Hospital of Southern Medical University from 01/1998 to 07/2021 who had preoperative fasting blood glucose(FPG)values measured.The primary outcome of this study was the occurrence of PPCs in patients 7 days postoperatively(during hospitalization),and we determined whether patients had PPCs by the European Perioperative Clinical Outcome(EPCO)and the recommended diagnostic criteria of Abbott et al.A univariate analysis was performed for the PPCs and nonPPCs groups,and independent variables with statistically significant differences(P<0.10)or strong relationships with PPCs were screened.A multifactorial Logistic regression model was established to analyze the relationship between preoperative FPG levels and PPCs.The association between preoperative FPG and PPCs and secondary outcomes(pulmonary atelectasis,pneumonia,respiratory failure and aspiration pneumonia,prolonged length of stay,and ICU admission)was assessed predictively by fitting restricted cubic splines to a continuous model.Results:This study ultimately included 7516 patients undergoing thoracic surgery,and the incidence of PPCs was 29.8%([95%CI]28.8%-30.9%).Multifactorial logistic regression analysis revealed that preoperative FPG level,gender,body mass index,history of COPD,hypoproteinemia,anemia,ASA grade,emergency surgery,surgical site,duration of surgery,neuromuscular reversal,and intraoperative morphine equivalent were independent influences on PPCs in patients undergoing thoracic surgery.Restricted cubic spline analysis found that low levels of preoperative FPG increased the incidence of PPCs,prolonging the length of stay,while high levels of preoperative FPG increased the rate of postoperative ICU admission.Conclusion:Preoperative FPG is an independent influence on PPCs in patients undergoing thoracic surgery.Low levels of preoperative FPG increase the incidence of PPCs and prolong the length of stay,while high levels of preoperative FPG increase the rate of postoperative ICU admission.