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Home > Vascular Annual Meeting^® > RR3. Association of Postoperative Glucose Level...

RR3. Association of Postoperative Glucose Level with Non-Lethal Complications After Carotid Endarterectomy

Anit Vettukattil1,2, Chad Cryer1,3, Robyn Macsata1, Owen Johnson, III3, Mark Slidell2, Subodh Arora1,4, Richard Amdur1, Anton Sidawy1,2,4
1VA Medical Center, Washington, DC; 2Georgetown University Hospital, Washington, DC; 3Walter Reed Army Medical Center, Washington, DC; 4George Washington University, Washington, DC

OBJECTIVES: To determine if 30-day complications following carotid endarterectomy (CEA) are increased in the presence of 48-hour postoperative hyperglycemia.

METHODS: This was a retrospective analysis of prospectively collected data by the Veterans Affairs National Surgical Quality Improvement Program (January 2000-December 2005) of all patients who underwent CEA repair. Average normal glucose was defined as 80-120 mg/dl and was used as the reference for comparison with all other glucose ranges: >120-160 mg/dl, >160-200 mg/dl, >200 mg/dl. The measured outcomes included adjusted odds ratio (OR) of myocardial infarction (MI), cerebrovascular accidents (CVA), respiratory complications, and incidence of two or more complications. To adjust for differences in demographics, operative factors, and preoperative comorbidities, we used multiple logistic regression.

RESULTS: Overall, 10,546 patients underwent CEAs. The percentage of patients in each glucose range were as follows: 80-120 mg/dl (38.6%), >120-160 mg/dl (37.8%), >160-200 mg/dl (13.9%), >200 mg/dl (9.7%). Univariate analysis of the data revealed that hyperglycemia greater than 120mg/dl was associated with increased risk of MI, CVA, respiratory complication, and the likelihood of having two or more complications. Multivariate analysis confirmed that serum glucose greater than 120mg/dl was associated with an increase in OR for MI 2.01 (1.23-3.27), CVA 2.20 (1.48-3.29), respiratory complication 1.81 (1.28-2.54), and incidence of two or more complications 1.82 (1.05-3.14). Also, odds ratio of complications increased with each increase in glucose range, as shown in Table 1.

CONCLUSIONS: Postoperative hyperglycemia above 120mg/dl is associated with an increased risk of complications following CEA. The magnitude of increased risk is directly proportional to the level of hyperglycemia, indicating that hyperglycemia-associated morbidity may be mitigated even if glucose cannot be strictly controlled to normoglycemic levels.

AUTHOR DISCLOSURES: A. Vettukattil, None; C. Cryer, None; R. Macsata, None; O. Johnson, None; M. Slidell, None; S. Arora, None; R. Amdur, None; A. Sidawy, None.

Table 1.