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Hyperglycemia

The document discusses the impact of perioperative hyperglycemia on postoperative complications in non-diabetic surgical patients, highlighting that hyperglycemia can lead to increased risks of surgical site infections, strokes, myocardial infarctions, and death. It emphasizes the need for better glycemic control during the perioperative period, as many surgical centers currently lack glucose testing for non-diabetic patients. The proposed study aims to evaluate the correlation between perioperative hyperglycemia and surgical complications using a quantitative, correlational research design.

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277 views9 pages

Hyperglycemia

The document discusses the impact of perioperative hyperglycemia on postoperative complications in non-diabetic surgical patients, highlighting that hyperglycemia can lead to increased risks of surgical site infections, strokes, myocardial infarctions, and death. It emphasizes the need for better glycemic control during the perioperative period, as many surgical centers currently lack glucose testing for non-diabetic patients. The proposed study aims to evaluate the correlation between perioperative hyperglycemia and surgical complications using a quantitative, correlational research design.

Uploaded by

shannon
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© © All Rights Reserved
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HYPERGLYCEMIA IN

NONDIABETIC SURGICAL
PATIENTS
Shannon McNulty
Brenda Marshall, EdD, APRN, ANEF, FAANP
William Paterson University
NUR 6021
Introduction & Hypothesis
Introduction
■ The stress of surgery and anesthesia causes the release of hormones, decreased insulin production,
and increased lipolysis (Kim et al., 2019).
■ Patients without diabetes mellitus (DM) with hyperglycemia may be more likely to suffer
complications in the postoperative period (Thompson et al., 2019).
■ Perioperative hyperglycemia is defined as blood glucose level greater than 140 mg/dL and occurs
in about 40% of surgical patients (Chen et al., 2022).
■ Poor perioperative glycemic control in non-diabetic patients is directly correlated to a 30-day
mortality and wound complications (Long et al., 2019).
■ Many hospitals and surgical centers do not have perioperative glucose testing for nondiabetic
patients.
Hypothesis
■ The hypothesis for this study is adequate glycemic control (glucose level less than 140 mg/dL) and
insulin mitigation can improve risk of infection and postoperative complications, such as stroke,
MI, and death.
Purpose/ Research Question

Purpose
■ The purpose of this project is to determine if perioperative hyperglycemia has an effect
on the rate of surgical site infection (SSI), stroke, myocardial infarction (MI), and death
in patients without diabetes.

Research Question
■ Does perioperative glycemic control (glucose less than 140 mg/dL) decrease risk of
infection and death in nondiabetic surgical patients?
Article 1 & Article 2: Preoperative Hyperglycemia
and Postoperative Complications

■ Dougherty et al. (2021) reviewed the relationship between preoperative glucose concentrations
immediately before an elective surgical procedure (up to six hours before) and postoperative
complications. The article was a retrospective cohort study conducted in an academic medical center.
The study defined hyperglycemia in three subgroups – mild (>140mg/dL), moderate (>180mg/dL), and
severe (>250mg/dL) (Dougherty et al., 2021). There was a correlation between immediate preoperative
mild or moderate hyperglycemia with postoperative complications. Preoperative hyperglycemia is
directly linked to an increased in adverse postoperative outcomes (Dougherty et al., 2021).
■ Showen et al. (2017) suggests that glycemic control throughout the entire operative period
(preoperative, perioperative, and postoperative) will reduce SSIs in surgical patients. The research was
conducted in a 377-bed public teaching hospital and found a strong correlation between preoperative
and postoperative hyperglycemia and the development in SSI in general surgery and vascular surgery
patients (Showen et al., 2017). The research was a cohort design and the overall rate of SSI was 9.6%
(Showen et al., 2017).
Article 3: SSI and Hyperglycemia

■ Bellusse et al. (2020) researched the effect of hyperglycemia on SSI in abdominal


surgery patients. The study was conducted between July 2016 and May 2017 and it
included 484 abdominal surgery patients. Data was collected through interviews and
patient assessments in the perioperative period and in the postoperative period (Bellusse
et al., 2020). The rate of SSI was 20.25% and the patients who also had perioperative
hyperglycemia was greater than 60% (Bellusse et al., 2020). The study suggests that
perioperative hyperglycemia is directly linked to the incidence of SSI. Perioperative
glycemic control management is important for the avoidance of SSI in patients
undergoing abdominal surgeries.
Proposed Methodology

Research Method/ Design:


■ The design will be a quantitative, correlational study. More specifically, it will be a
correlational quantitative research method. In correlational studies, the researcher does
not control the variables in the study (Lau, 2017). In this research project, it will
evaluate the risk of hyperglycemia and the effect on surgical complications by
reviewing the data over a 30-day period.
Sampling Techniques/ Setting:
■ A sample of 100 individuals will be tested. All subjects will be between the ages of 18-
65 and have no history of diabetes. All individuals will have elective abdominal
procedures in a acute care facility in northern NJ.
Proposed Data Collection and Analysis
Data Collection
Data Analysis
■ The researcher will use a glucometer to determine
perioperative glucose reading. • Descriptive statistics were analyzed to review

■ Key data sets: the correlation between perioperative


– Adults between the ages of 18-65 hyperglycemia (glucose >140mg/ dL) and the
– Having elective abdominal surgery risk of postoperative complications (SSI, MI,
– No history of diabetes mellitus stroke, and death).
Demographics • SPSS was used to review the data presented
■ Number of subjects and Pearson Correlation was reviewed to
■ Gender (M/F) determine correlation between glucose reading
■ Medical comorbidities and postoperative complications
■ Perioperative glucose
■ Presence of postoperative complication (SSI, MI,
stroke, death)
References
Bellusse, G.C., Ribeiro, J.C., Martins de Freitas, I.C., Galvao, C.M. (2020). Effect of perioperative
hyperglycemia on surgical site infection in abdominal surgery: A prospective cohort study. American
Journal of Infection Control., 48(7), 781–785.

Chen, J. Y., Nassereldine, H., Cook, S. B., Thornblade, L. W., Dellinger, E. P., & Flum, D. R. (2022).
Paradoxical association of hyperglycemia and surgical complications among patients with and without
diabetes. JAMA surgery, 157(9), 765–770. https://doi.org/10.1001/jamasurg.2021.5561

Dougherty, S. M., Schommer, J., Salinas, J. L., Zilles, B., Belding-Schmitt, M., Rogers, W. K., Shibli-
Rahhal, A., & O'Neill, B. T. (2021). Immediate preoperative hyperglycemia correlates with
complications in non-cardiac surgical cases. Journal of clinical anesthesia, 74, 110375.
https://doi.org/10.1016/j.jclinane.2021.110375

Kim, S., Park, J., Kim, H., Yang, K., Choi, J., Kim, K., Sung, J., Ahn, J., & Lee, S.-H. (2021).
Intraoperative hyperglycemia may be associated with an increased risk of myocardial injury after
non-cardiac surgery in diabetic patients. Journal of Clinical Medicine, 10(22), 5219.
https://doi.org/10.3390/jcm10225219
Lau F. (2017). Methods for correlational studies. Handbook of eHealth Evaluation: An Evidence-based Approach.
Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK481614/

Long, C. A., Fang, Z. B., Hu, F. Y., Arya, S., Brewster, L. P., Duggan, E., & Duwayri, Y. (2019). Poor glycemic
control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgery. Journal
of vascular surgery, 69(4), 1219–1226. https://doi.org/10.1016/j.jvs.2018.06.212

Showen, A., B.A., Russell, Tara A,M.D., M.P.H., Young, S., M.D., Gupta, S., M.D., & Gibbons, Melinda M,M.D.,
M.S.H.S. (2017). Hyperglycemia Is Associated with Surgical Site Infections among General and Vascular Surgery
Patients. The American Surgeon, 83(10), 1108-1111.
https://ezproxy.wpunj.edu/login?url=https://www.proquest.com/scholarly-journals/hyperglycemia-is- associated-with-
surgical-site/docview/1961745943/se-2

Thompson, R., Khor, S., Thornblade, L. W., Flum, D. R., & Sobel, M. (2019). The Paradox of hyperglycemia and
surgical outcomes in patients with and without diabetes. Surgical infections, 20(4), 338–339.
https://doi.org/10.1089/sur.2018.270

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