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Glycemic instability of non-diabetic patients after spine surgery: a prospective cohort study

European Spine Journal volume 23, pages 2455–2461 (2014)Cite this article

Abstract

Purpose

Blood glucose (BG) dysregulation is a well-known condition for patients sustaining medical adverse events, such as sepsis or myocardial infarction. However, it has never been described following spine surgery. Our purpose was to assess postoperative glycemic dysregulation of non-diabetic patients undergoing spine surgery and determine if this is related to any complications within a 3-month postoperative period.

Methods

All the non-diabetic patients undergoing spine surgery in our center were prospectively included over a 6-month period. BG capillary measures were collected from the preoperative fasting period to the end of postoperative Day 3, six times a day. Patients were followed for 3 months after surgery.

Results

Data collected from 75 patients were eventually analyzed. A significant increase of BG level was observed from the preoperative to the second postoperative hour (P < 0.0001), remaining significantly elevated until Day 3 (P < 0.0001). Significant correlations were found between perioperative factors (age, smoking, revision status, instrumentation, operation time, blood loss and transfusion) and glycemic parameters. Day 2 mean BG level was found significantly higher for patients surgically revised than those not revised (P = 0.04).

Conclusions

Non-diabetic patients experience a statistically significant increase in BG levels in the first 3 days following a spine surgery. This increase in BG might be correlated with postsurgical complications.

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Abbreviations

BG:

Blood glucose

D0:

Day of surgery

D1/2/3:

First/second/third day following surgery

BF−0.5/BF+2/L−0.5/L+2/D−0.5/D+2:

30 min before and 2 h after breakfast, lunch and dinner

HGI:

Hyperglycemic index

SD:

Standard deviation

References

  1. Lipshutz AK, Gropper MA (2009) Perioperative glycemic control: an evidence-based review. Anesthesiology 110(2):408–421

    PubMed  Google Scholar 

  2. Thorell A, Efendic S, Gutniak M, Häggmark T, Ljungqvist O (1993) Development of postoperative insulin resistance is associated with the magnitude of operation. Eur J Surg 159(11–12):593–599

    PubMed  CAS  Google Scholar 

  3. Subramaniam B, Panzica PJ, Novack V, Mahmood F, Matyal R, Mitchell JD, Sundar E, Bose R, Pomposelli F, Kersten JR, Talmor DS (2009) Continuous perioperative insulin infusion decreases major cardiovascular events in patients undergoing vascular surgery: a prospective, randomized trial. Anesthesiology 110(5):970–977

    PubMed  Article  CAS  Google Scholar 

  4. Vanhorebeek I, Ingels C, Van den Berghe G (2006) Intensive insulin therapy in high-risk cardiac surgery patients: evidence from the Leuven randomized study. Semin Thorac Cardiovasc Surg 18(4):309–316

    PubMed  Article  Google Scholar 

  5. Atkins J, Smith D (2009) A review of perioperative glucose control in the neurosurgical population. J Diabetes Sci Technol 3(6):1352–1364

    PubMed  Article  PubMed Central  Google Scholar 

  6. Pili-Floury S, Mitifiot F, Penfornis A, Boichut N, Tripart MH, Christophe JL, Garbuio P, Samain E (2009) Glycaemic dysregulation in nondiabetic patients after major lower limb prosthetic surgery. Diabetes Metab 35(1):43–48

    PubMed  Article  CAS  Google Scholar 

  7. Kragsbjerg P, Holmberg H, Vikerfors T (1995) Serum concentrations of interleukin-6, tumour necrosis factor-alpha, and C-reactive protein in patients undergoing major operations. Eur J Surg 161(1):17–22

    PubMed  CAS  Google Scholar 

  8. Demura S, Takahashi K, Kawahara N, Watanabe Y, Tomita K (2006) Serum interleukin-6 response after spinal surgery: estimation of surgical magnitude. J Orthop Sci 11(3):241–247

    PubMed  Article  CAS  Google Scholar 

  9. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A (2003) Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:1007–1021

    PubMed  Article  CAS  Google Scholar 

  10. Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP (2009) The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Jt Surg Am 91(7):1621–1629

    Article  Google Scholar 

  11. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Jt Surg Am 90(1):62–69

    Article  Google Scholar 

  12. Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, Yang Y, Zhu SW, Ma BY, Feng R (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22(3):605–615

    PubMed  Article  PubMed Central  Google Scholar 

  13. Drouin P, Blickle JF, Charbonnel B, Eschwege E, Guillausseau PJ, Plouin PF, Daninos JM, Balarac N, Sauvanet JP (1999) Diagnosis and classification of diabetes mellitus: the new criteria. Diabetes Metab 25:72–83

    PubMed  CAS  Google Scholar 

  14. Vogelzang M, van der Horst IC, Nijsten MW (2004) Hyperglycaemic index as a tool to assess glucose control: a retrospective study. Crit Care 8(3):R122–R127

    PubMed  Article  PubMed Central  Google Scholar 

  15. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345(19):1359–1367

    PubMed  Article  Google Scholar 

  16. Agence française de sécurité sanitaire des produits de santé (2006) Transfusion de globules rouges homologues: produits, indications, alternatives. http://afssaps.sante.fr/pdf/5/rbp/glreco.pdf

  17. Service FJ, Nelson RL (1980) Characteristics of glycemic stability. Diabetes Care 3(1):58–62

    PubMed  Article  CAS  Google Scholar 

  18. Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, Rogers SO (2008) Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg 248(4):585–591

    PubMed  Google Scholar 

  19. Richards JE, Kauffmann RM, Zuckerman SL, Obremskey WT, May AK (2012) Relationship of hyperglycemia and surgical-site infection in orthopaedic surgery. J Bone Jt Surg Am 94(13):1181–1186

    Article  Google Scholar 

  20. Bochicchio GV, Sung J, Joshi M, Bochicchio K, Johnson SB, Meyer W, Scalea TM (2005) Persistent hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 58(5):921–924

    PubMed  Article  Google Scholar 

  21. Vogelzang M, Nijboer JM, van der Horst IC, Zijlstra F, ten Duis HJ, Nijsten NW (2006) Hyperglycemia has a stronger relation with outcome in trauma patients than in other critically ill patients. J Trauma 60(4):873–877 discussion 878–9

    PubMed  Article  Google Scholar 

  22. Yendamuri S, Fulda GJ, Tinkoff GH (2003) Admission hyperglycemia as a prognostic indicator in trauma. J Trauma 55(1):33–38

    PubMed  Article  CAS  Google Scholar 

  23. Kopelman TR, O’Neill PJ, Kanneganti SR, Davis KM, Drachman DA (2008) The relationship of plasma glucose and glycosylated hemoglobin A1C levels among nondiabetic trauma patients. J Trauma 64(1):30–33 discussion 33–4

    PubMed  Article  Google Scholar 

  24. Street JT, Lenehan BJ, DiPaola CP, Boyd MD, Kwon BK, Paquette SJ, Dvorak MF, Rampersaud YR, Fisher CG (2012) Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients. Spine J 12(1):22–34

    PubMed  Article  Google Scholar 

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Acknowledgments

Dr. David Bichara for improving the overall quality of the manuscript. Financial support for this study was entirely provided by our department.

Conflict of interest

The authors have no conflict of interests related to this study.

Author information

Affiliations

  1. Service de chirurgie orthopédique et traumatologique, Hôpital Beaujon, 100 boulevard Général Leclerc, 92100, Clichy, France

    Jean Langlois, Benjamin Bouyer, Cyril Dauzac & Pierre Guigui

  2. Unité d’Epidémiologie et de Recherche Clinique, Hôpital Beaujon, 100 boulevard Général Leclerc, 92100, Clichy, France

    Béatrice Larroque

Authors
  1. Jean Langlois
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  2. Benjamin Bouyer
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  3. Béatrice Larroque
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  4. Cyril Dauzac
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  5. Pierre Guigui
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Corresponding author

Correspondence to Jean Langlois.

Additional information

Béatrice Larroque deceased before manuscript acceptance.

Clinical trial registration number: NCT01975883.

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Langlois, J., Bouyer, B., Larroque, B. et al. Glycemic instability of non-diabetic patients after spine surgery: a prospective cohort study. Eur Spine J 23, 2455–2461 (2014). https://doi.org/10.1007/s00586-014-3489-2

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  • DOI: https://doi.org/10.1007/s00586-014-3489-2

Keywords

  • Blood glucose
  • Hyperglycaemia
  • Spine surgery
  • Reoperation