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Perioperative Glycemic Control During Colorectal Surgery

  • Hospital Management of Diabetes (GE Umpierrez, Section Editor)
  • Published:
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Abstract

Hyperglycemia occurs frequently among patients undergoing colorectal surgery and is associated with increased risk of poor clinical outcomes, especially related to surgical site infections. Treating hyperglycemia has become a target of many enhanced recovery after surgery programs developed for colorectal procedures. There are several unique considerations for patients undergoing colorectal surgery including bowel preparations and alterations in oral intake. Focused protocols for those with diabetes and those at risk of hyperglycemia are needed in order to address the specific needs of those undergoing colorectal procedures.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Patient information for laparoscopic colon resection surgery from SAGES. (Accessed 9/17/15, 2015, at http://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-colon-resection-from-sages/)

  2. Murray BW, Huerta S, Dineen S, Anthony T. Surgical site infection in colorectal surgery: a review of the nonpharmacologic tools of prevention. J Am Coll Surg. 2010;211:812–22.

    Article  PubMed  Google Scholar 

  3. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370:1198–208.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Frisch A, Chandra P, Smiley D, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010;33:1783–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013;257:8–14. This study provided a statewide analysis including 47 hospitals, demonstrating the association of perioperative hyperglycemia and worse surgical outcomes.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978–82.

    Article  CAS  PubMed  Google Scholar 

  7. Kiran RP, Turina M, Hammel J, Fazio V. The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal surgery: evidence for the need for tight glucose control? Ann Surg. 2013;258:599–604. discussion -5.

    PubMed  Google Scholar 

  8. Mohan S, Kaoutzanis C, Welch KB, et al. Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database. Int J Colorectal Dis. 2015.

  9. Ata A, Lee J, Bestle SL, Desemone J, Stain SC. Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg. 2010;145:858–64.

    Article  PubMed  Google Scholar 

  10. Cao S, Zhou Y, Chen D, et al. Intensive versus conventional insulin therapy in nondiabetic patients receiving parenteral nutrition after D2 gastrectomy for gastric cancer: a randomized controlled trial. J Gastrointest Surg. 2011;15:1961–8.

    Article  PubMed  Google Scholar 

  11. Furnary AP, Wu Y. Eliminating the diabetic disadvantage: the Portland Diabetic Project. Semin Thorac Cardiovasc Surg. 2006;18:302–8.

    Article  PubMed  Google Scholar 

  12. Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas Jr CS. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol. 2001;22:607–12.

    Article  CAS  PubMed  Google Scholar 

  13. McAlister FA, Man J, Bistritz L, Amad H, Tandon P. Diabetes and coronary artery bypass surgery: an examination of perioperative glycemic control and outcomes. Diabetes Care. 2003;26:1518–24.

    Article  PubMed  Google Scholar 

  14. McConnell YJ, Johnson PM, Porter GA. Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointest Surg. 2009;13:508–15.

    Article  PubMed  Google Scholar 

  15. Ramos M, Khalpey Z, Lipsitz S, et al. Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg. 2008;248:585–91.

    PubMed  Google Scholar 

  16. Schmeltz LR, DeSantis AJ, Thiyagarajan V, et al. Reduction of surgical mortality and morbidity in diabetic patients undergoing cardiac surgery with a combined intravenous and subcutaneous insulin glucose management strategy. Diabetes Care. 2007;30:823–8.

    Article  CAS  PubMed  Google Scholar 

  17. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.

    Article  PubMed  Google Scholar 

  18. Vilar-Compte D, Alvarez de Iturbe I, Martin-Onraet A, Perez-Amador M, Sanchez-Hernandez C, Volkow P. Hyperglycemia as a risk factor for surgical site infections in patients undergoing mastectomy. Am J Infect Control. 2008;36:192–8.

    Article  PubMed  Google Scholar 

  19. Vriesendorp TM, DeVries JH, Hulscher JB, Holleman F, van Lanschot JJ, Hoekstra JB. Early postoperative hyperglycaemia is not a risk factor for infectious complications and prolonged in-hospital stay in patients undergoing oesophagectomy: a retrospective analysis of a prospective trial. Crit Care. 2004;8:R437–42.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:356–61.

    Article  CAS  PubMed  Google Scholar 

  21. Ata A, Valerian BT, Lee EC, Bestle SL, Elmendorf SL, Stain SC. The effect of diabetes mellitus on surgical site infections after colorectal and noncolorectal general surgical operations. Am Surg. 2010;76:697–702.

    PubMed  Google Scholar 

  22. Tanner J, Padley W, Assadian O, Leaper D, Kiernan M, Edmiston C. Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery. 2015;158:66–77.

    Article  PubMed  Google Scholar 

  23. Dahabreh IJ, Steele DW, Shah N, Trikalinos TA. Oral mechanical bowel preparation for colorectal surgery: systematic review and meta-analysis. Dis Colon Rectum. 2015;58:698–707.

    Article  PubMed  Google Scholar 

  24. Ozturk NA, Gokturk HS, Demir M, Unler GK, Gur G, Yilmaz U. Efficacy and safety of sodium phosphate for colon cleansing in type 2 diabetes mellitus. South Med J. 2010;103:1097–102.

    Article  PubMed  Google Scholar 

  25. Taylor C, Schubert ML. Decreased efficacy of polyethylene glycol lavage solution (GoLYTELY) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study. Am J Gastroenterol. 2001;96:710–4.

    Article  CAS  PubMed  Google Scholar 

  26. Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014;96:15–22.

    Article  CAS  PubMed  Google Scholar 

  27. Hahl T, Peromaa-Haavisto P, Tarkiainen P, Knutar O, Victorzon M. Outcome of laparoscopic gastric bypass (LRYGB) with a program for enhanced recovery after surgery (ERAS). Obes Surg. 2015.

  28. Barreca M, Renzi C, Tankel J, Shalhoub J, Sengupta N. Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center. Surg Obes Relat Dis. 2015.

  29. Gustafsson UO, Nygren J, Thorell A, et al. Pre-operative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand. 2008;52:946–51.

    Article  CAS  PubMed  Google Scholar 

  30. Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012;11, CD008879.

    PubMed  Google Scholar 

  31. Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34:256–61. This randomized controlled trial found improved perioperative outcomes when implementing basal-bolus insulin regimens compared to sliding scale alone.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Umpierrez GE, Smiley D, Hermayer K, et al. Randomized study comparing a basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: basal plus trial. Diabetes Care. 2013;36:2169–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Rachel E. Thompson.

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Conflict of Interest

Rachel E. Thompson, Elizabeth K. Broussard, and David R. Flum declare that they have no conflict of interest. Brent E. Wisse is a consultant for Transformative Medicine.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Hospital Management of Diabetes

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Thompson, R.E., Broussard, E.K., Flum, D.R. et al. Perioperative Glycemic Control During Colorectal Surgery. Curr Diab Rep 16, 32 (2016). https://doi.org/10.1007/s11892-016-0722-x

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  • DOI: https://doi.org/10.1007/s11892-016-0722-x

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