Effects of perioperative tight glycemic control on postoperative outcomes: a meta-analysis

Zhou-Qing Kang, Jia-Ling Huo, Xiao-Jie Zhai, Zhou-Qing Kang, Jia-Ling Huo, Xiao-Jie Zhai

Abstract

Background The optimal glycemic target during the perioperative period is still controversial. We aimed to explore the effects of tight glycemic control (TGC) on surgical mortality and morbidity. Methods PubMed, EMBASE and CENTRAL were searched from January 1, 1946 to February 28, 2018. Appropriate trails comparing the postoperative outcomes (mortality, hypoglycemic events, acute kidney injury, etc.) between different levels of TGC and liberal glycemic control were identified. Quality assessments were performed with the Jadad scale combined with the allocation concealment evaluation. Pooled relative risk (RR) and 95% CI were calculated using random effects models. Heterogeneity was detected by the I2 test. Results Twenty-six trials involving a total of 9315 patients were included in the final analysis. The overall mortality did not differ between tight and liberal glycemic control (RR, 0.92; 95% CI, 0.78-1.07; I 2 = 20.1%). Among subgroup analyses, obvious decreased risks of mortality were found in the short-term mortality, non-diabetic conditions, cardiac surgery conditions and compared to the very liberal glycemic target. Furthermore, TGC was associated with decreased risks for acute kidney injury, sepsis, surgical site infection, atrial fibrillation and increased risks of hypoglycemia and severe hypoglycemia. Conclusions Compared to liberal control, perioperative TGC (the upper level of glucose goal ≤150 mg/dL) was associated with significant reduction of short-term mortality, cardic surgery mortality, non-diabetic patients mortality and some postoperative complications. In spite of increased risks of hypoglycemic events, perioperative TGC will benefits patients when it is done carefully.

Keywords: perioperative; surgical morbidity; surgical mortality; tight glycemic control.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Random effects meta-analysis of the effect of perioperative tight glycemic control on mortality, stratified by different intensity of glucose control target.
Figure 3
Figure 3
Forest plot of subgroup analyses for mortality.
Figure 4
Figure 4
Comparison of postoperative morbidities between tight glycemic control and liberal control among surgical patients.
Figure 5
Figure 5
Begg’s funnel plot with 95% confidence limits (CIs) of publication bias test.

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