期刊
BRITISH JOURNAL OF SURGERY
卷 96, 期 11, 页码 1358-1364出版社
JOHN WILEY & SONS LTD
DOI: 10.1002/bjs.6724
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资金
- Swedish Research Council [09101]
- Torsten and Ragnar Soderberg Foundation
- Karolinska Institute, Sweden
- Hans Mellstrom, Sweden
- Royal Numico, The Netherlands
- Familijen Erling-Perssons Foundation
Background: Hyperglycaemia following major surgery increases morbidity, hut may he improved by use of enhanced-recovery protocols. It is not known whether preoperative haemaoglobin (Hb) A1c could predict hyperglycaemia and/or adverse outcome after colorectal surgery. Methods: Some 120 patients without known diabetes underwent major colorectal surgery within an enhanced-recovery protocol. HbA1c wits measured at admission and 4 weeks after surgery. All patients received an oral diet beginning 4 h after operation. Plasma glucose was monitored five times daily. Patients were stratified according to preoperative levels of HbA1c (within normal range of 4.5-6.0 per cent, or higher). Results: Thirty-one patients (25.8 per cent) had a preoperative HbA1c level over 6.0 per cent. These had higher mean(s.d.) postoperative glucose (9.3(1.5) versus 8.0(1.5) mmol/l: P < 0.001) anti C-reactive protein (137(65) versus 101(52) mg/l; P=0.008) levels than patients with a normal HbA1c level. Postoperative complications were more common in patients with a high HbA1c level (odds ratio 2.9 (95 per cent confidence interval 1.1 to 7.9)). Conclusion: Postoperative hyperglycaemia is common among patients with no history of diabetes, even within an enhanced-recovery protocol. Preoperative measurement of HbA1c may identify patients at higher risk of poor glycaemic control and postoperative complications.
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