Anastomotic Leak After Colectomy: Preop Hyperglycemia Ups Death Risk

VANCOUVER, B.C. – Anastomotic leaks after colectomy are more likely to be fatal in patients with preoperative hyperglycemia, based on the results of a database analysis.

Patients with diabetes were not at increased risk of an anastomotic leak. When leaks occurred, however, the associated mortality rate was 25% among those with diabetes and 3.6% among those without diabetes, Dr. Matthew Ziegler reported at the annual meeting of the American Society of Colon and Rectal Surgeons.

Dr. Ziegler, of the William Beaumont Hospital, Royal Oak, Mich., and his colleagues drew their findings from the database of the Michigan Surgical Quality Collaborative. The database included 3,977 patients who had a colectomy from February 2008 to March 2010. Of these, 700 were known to have diabetes. The researchers used a fasting blood glucose value greater than 140 mg/dL as the definition of hyperglycemia.

Fasting glucose values were tested preoperatively in 85% of the patients; 14% had hyperglycemia, and just over half of those patients had diabetes.

At 30 days after surgery, overall mortality was 5.5% for those with diabetes and 2.9% in those without diabetes. Mortality was 8%, which was significantly higher, in the nondiabetic patients with preoperative fasting hyperglycemia.

Parsing the data further, Dr. Ziegler and his colleagues found two risk factors – preoperative steroid use and emergent surgery – that were associated with anastomotic leaks in patients with diabetes. "This may be important, especially in colectomy patients, because of the high morbidity," he said. Dr. Ziegler added that he would hesitate to perform a colectomy on a patient with diabetes who is on preoperative steroids.

Many Americans have diabetes or are on the road to acquiring that disease, said Dr. Ziegler. In addition to the 18 million diagnosed with diabetes in the United States, an estimated 7 million have not yet been diagnosed and 79 million have prediabetes, with elevated fasting glucose or hemoglobin A_1c levels.

"Certainly [the findings] merit more study, and improved preoperative screening is needed to better identify and treat this complicated patient population," he said.

Dr. Ziegler said that his hospital has stepped up screening efforts to include preoperative fasting glucose levels and HbA₁c levels. "We also have just instituted a so-called ‘sugar nurse’ who is a nurse specialist who meets with patients preoperatively and works on their glycemic management perioperatively with hopefully better outcomes."

VANCOUVER, B.C. – Anastomotic leaks after colectomy are more likely to be fatal in patients with preoperative hyperglycemia, based on the results of a database analysis.

Patients with diabetes were not at increased risk of an anastomotic leak. When leaks occurred, however, the associated mortality rate was 25% among those with diabetes and 3.6% among those without diabetes, Dr. Matthew Ziegler reported at the annual meeting of the American Society of Colon and Rectal Surgeons.

Dr. Ziegler, of the William Beaumont Hospital, Royal Oak, Mich., and his colleagues drew their findings from the database of the Michigan Surgical Quality Collaborative. The database included 3,977 patients who had a colectomy from February 2008 to March 2010. Of these, 700 were known to have diabetes. The researchers used a fasting blood glucose value greater than 140 mg/dL as the definition of hyperglycemia.

Fasting glucose values were tested preoperatively in 85% of the patients; 14% had hyperglycemia, and just over half of those patients had diabetes.

At 30 days after surgery, overall mortality was 5.5% for those with diabetes and 2.9% in those without diabetes. Mortality was 8%, which was significantly higher, in the nondiabetic patients with preoperative fasting hyperglycemia.

Parsing the data further, Dr. Ziegler and his colleagues found two risk factors – preoperative steroid use and emergent surgery – that were associated with anastomotic leaks in patients with diabetes. "This may be important, especially in colectomy patients, because of the high morbidity," he said. Dr. Ziegler added that he would hesitate to perform a colectomy on a patient with diabetes who is on preoperative steroids.

Many Americans have diabetes or are on the road to acquiring that disease, said Dr. Ziegler. In addition to the 18 million diagnosed with diabetes in the United States, an estimated 7 million have not yet been diagnosed and 79 million have prediabetes, with elevated fasting glucose or hemoglobin A_1c levels.

"Certainly [the findings] merit more study, and improved preoperative screening is needed to better identify and treat this complicated patient population," he said.

Dr. Ziegler said that his hospital has stepped up screening efforts to include preoperative fasting glucose levels and HbA₁c levels. "We also have just instituted a so-called ‘sugar nurse’ who is a nurse specialist who meets with patients preoperatively and works on their glycemic management perioperatively with hopefully better outcomes."

VANCOUVER, B.C. – Anastomotic leaks after colectomy are more likely to be fatal in patients with preoperative hyperglycemia, based on the results of a database analysis.

Patients with diabetes were not at increased risk of an anastomotic leak. When leaks occurred, however, the associated mortality rate was 25% among those with diabetes and 3.6% among those without diabetes, Dr. Matthew Ziegler reported at the annual meeting of the American Society of Colon and Rectal Surgeons.

Dr. Ziegler, of the William Beaumont Hospital, Royal Oak, Mich., and his colleagues drew their findings from the database of the Michigan Surgical Quality Collaborative. The database included 3,977 patients who had a colectomy from February 2008 to March 2010. Of these, 700 were known to have diabetes. The researchers used a fasting blood glucose value greater than 140 mg/dL as the definition of hyperglycemia.

Fasting glucose values were tested preoperatively in 85% of the patients; 14% had hyperglycemia, and just over half of those patients had diabetes.

At 30 days after surgery, overall mortality was 5.5% for those with diabetes and 2.9% in those without diabetes. Mortality was 8%, which was significantly higher, in the nondiabetic patients with preoperative fasting hyperglycemia.

Parsing the data further, Dr. Ziegler and his colleagues found two risk factors – preoperative steroid use and emergent surgery – that were associated with anastomotic leaks in patients with diabetes. "This may be important, especially in colectomy patients, because of the high morbidity," he said. Dr. Ziegler added that he would hesitate to perform a colectomy on a patient with diabetes who is on preoperative steroids.

Many Americans have diabetes or are on the road to acquiring that disease, said Dr. Ziegler. In addition to the 18 million diagnosed with diabetes in the United States, an estimated 7 million have not yet been diagnosed and 79 million have prediabetes, with elevated fasting glucose or hemoglobin A_1c levels.

"Certainly [the findings] merit more study, and improved preoperative screening is needed to better identify and treat this complicated patient population," he said.

Dr. Ziegler said that his hospital has stepped up screening efforts to include preoperative fasting glucose levels and HbA₁c levels. "We also have just instituted a so-called ‘sugar nurse’ who is a nurse specialist who meets with patients preoperatively and works on their glycemic management perioperatively with hopefully better outcomes."