Newly diagnosed hyperglycemia in the perioperative settings at Kigali university teaching hospital (CHUK): Prevalence, risk factors and impact on immediate patients'clinical outcome

Abstract

Background: Perioperative hyperglycemia is a common condition in adult patients presenting at hospital for surgery and is associated with poor clinical outcome including the risk of developing postoperative infection, cardiovascular and neurological events, increased hospital stay and mortality. No study has described so far the prevalence, risk factors and complications related to perioperative hyperglycemia among adult patients attending Rwandan hospitals for surgical procedures. The aim of our study was to determine the prevalence of newly diagnosed perioperative hyperglycemia, its risk factors and its impact on immediate patients’ clinical outcome in terms of infectious complications and length of hospital stay at CHUK. Methods: This was prospective cross-sectional study of adult patients presenting for surgery at CHUK from October 16th 2013 to January 13th 2014. We recorded the patients’ characteristics and the pre-, intra- and postoperative fasting capillary blood sugar. The clinical outcome (length of hospital stay and infection) has been assessed within 30 days during the postoperative hospital stay. Risk factors were studied by univariate and multivariate logistic regression analysis. P-value ≤ 0.05 was significant. Results: The study enrolled 400 adult patients with a mean age of 40.29 ± 16.89 years. The majority 261 (65.2%) of patients were male. The pre-, intra- and postoperative prevalence of hyperglycemia were respectively 35.0%, 62.5% and 31.0%. Older adults, ASA class II&III, surgical wound class II&III and hypertension were independent risk factors of preoperative hyperglycemia which predicted the intraoperative and postoperative hyperglycemia. The postoperative infection happened in 16.8% patients. Those who were preoperatively hyperglycemic had 5.4 times the risk of developing the postoperative infection and 3 times the risk of having prolonged postoperative hospital stay. Conclusion: The perioperative hyperglycemia is common in adult patients undergoing surgery at CHUK. Its associated risk factors included older adults, ASA class II&III, surgical wound class II&III and hypertension. The intraoperative and postoperative hyperglycaemia correlated with preoperative hyperglycemia which independently was the risk factor of postoperative infection and long hospital stay.