Admission Preoperative Glucose is Predictive of Morbidity and Mortality in Trauma Patients who Require Immediate Operative Intervention

Abstract

Although there have been reports in the surgical literature regarding the negative effects of preoperative hyperglycemia on outcome, the impact of elevated preoperative serum glucose levels in trauma patients is unknown. Our objectives were to determine whether preoperative hyperglycemia was associated with a greater morbidity and mortality in trauma patients who underwent surgical intervention upon admission. Prospective data was collected on 252 consecutive nondiabetic trauma patients admitted for ≥3 days who went directly to the OR from the resuscitation area. Patients were stratified by preoperative serum glucose level (<200 vs. ≥200 mg/dL) age, gender, Injury Severity Score (ISS), and other preexisting risk factors. Outcome was measured by incidence of infection, hospital (HLOS) and ICU (ILOS) length of stay, and mortality. Multiple linear regression models were used to evaluate serum glucose in relation to other preoperative risk factors. Blunt trauma accounted for the majority (86%) of the injuries. Orthopedic procedures were the most common (36%) followed by neurosurgical (22%), abdominal (22%), and thoracic (6%). Patients with elevated serum glucose had a significantly greater incidence of infection, HLOS, ILOS, and mortality matched per age and ISS. Elevated serum glucose on admission is an accurate predictor of postoperative infection, HLOS, ILOS, and mortality. A randomized prospective trial evaluating the impact of preoperative glucose control is warranted.