While the impact of poorly controlled Diabetes on surgical outcomes of patients undergoing lower extremity revascularization is well-known, it is not clear if immediate postoperative hyperglycemia (IPH) itself can be used as a surrogate for poor outcomes following peripheral arterial bypass. We sought to examine the effect of IPH in this patient population with its impact on short-term and long-term outcomes.
Retrospective review was completed for 505 patients who underwent either suprainguinal bypass surgery (SBS) or infrainguinal bypass surgery (IBS) between July 2002 and April 2018 for the treatment of peripheral arterial disease. All patients were undergoing first-time open bypass grafting (BG). Patients were stratified into those who were normoglycemic or hyperglycemic (glucose ≥ 140) within 24 hours following surgery. Comparative analysis was performed on comorbidities and outcomes.
Of 505 patients who underwent BG, 255 patients (50.5%) were hyperglycemic. The mean age of patients was 63.5 ± 14.1 years. Median follow up was 5.2 years (range 0.0-15.2 years). Distribution of procedures was as follows: femoral to popliteal bypasses (29%), femoral to femoral bypasses (17%), femoral to tibial bypasses (12%), aortobifemoral bypasses (10%), iliofemoral bypasses (9%), and axillofemoral bypasses (7%). At 30-days, hyperglycemic patients had increased incidence of limb loss (8.3% vs. 4%), myocardial infarction (4.8% vs. 0.8%) and incurred higher costs of hospital stay ($27,701 vs. $22,990) (all p<.05). At 10 years, these patients had higher incidence of needing major amputations (15.4% vs. 9.4%, p=.025). Hyperglycemia after infrainguinal bypass was associated with nearly twice the risk of limb loss at 5 years (HR 1.91, p=.034). Among the cohort of patients who required major amputations, the time duration between index revascularization and amputation was significantly shorter as compared to normoglycemic patients (p=.003).
In this single institution study with long-term follow up, IPH was associated with increased rates of 30-day amputation, myocardial infarction and increased cost of hospital stay. In the long-term, postoperative hyperglycemia was associated with greater major limb loss. Among the cohort of patients who required major amputations, time period between revascularization and amputation was shorter for those patients who had IPH. IPH is an independent marker for poor outcomes after lower extremity revascularization procedures.
Copyright © 2020. Published by Elsevier Inc.