ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2019 November;85(11):1201-10

DOI: 10.23736/S0375-9393.19.13748-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Intraoperative hyperglycemia increases the incidence of postoperative delirium

Victoria WINDMANN ¹, Claudia SPIES ¹ ✉, Cornelia KNAAK ¹, Tobias WOLLERSHEIM ^{1, 2}, Sophie K. PIPER ^{2, 3}, Gerald VORDERWÜLBECKE ¹, Maryam KURPANIK ¹, Sophia KUENZ ¹, Gunnar LACHMANN ^{1, 2} on behalf of the BIOCOG Consortium

¹ Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany; ² Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany; ³ Berlin Institute of Health, Berlin, Germany

BACKGROUND: Hyperglycemia frequently occurs during major surgery and is associated with adverse postoperative outcomes. This study aimed to investigate the influence of intraoperative hyperglycemia on incidences of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD).
METHODS: Eighty-seven patients aged ≥65 years undergoing elective surgery were included in this prospective observational subproject of the BioCog study. Blood glucose (BG) levels were measured every 20 minutes intraoperatively. Hyperglycemia was defined as BG levels ≥150 mg·dL-1. Patients were assessed for POD twice daily until postoperative day 7. The occurrence of POCD was determined three months after surgery. Multivariable logistic regression was used to identify associations between hyperglycemia and POD as well as POCD. Secondary endpoints comprised duration of hyperglycemia, maximum glucose level (Glucosemax) and differences between diabetic and non-diabetic patients.
RESULTS: POD occurred in 41 (47.1%), POCD in five (15.2%) patients. In two separate multivariable logistic regression models, hyperglycemia was significantly associated with POD (OR 3.86 [CI 95% 1.13, 39.49], P=0.044) but not POCD (3.59 [NaN, NaN], P=0.157). Relative duration of hyperglycemia was higher in POD patients compared to patients without POD (20 [0; 71] % versus 0 [0; 55] %, P=0.075), whereas the maximum glucose levels during surgery were similar between the two groups. Considering only non-diabetic patients, relative duration of hyperglycemia (P=0.003) and Glucosemax (P=0.015) were significantly higher in patients with POD.
CONCLUSIONS: Intraoperative hyperglycemia was independently associated with POD but not POCD. Relative duration of hyperglycemia appeared thereby to also play a role. Especially hyperglycemic non-diabetic patients might be at high risk for POD.

KEY WORDS: Hyperglycemia; Postoperative period; Delirium; Cognitive dysfunction; Diabetes complications