Abstract

Background: Chronic hyperglycaemia is a known post-colorectal surgery risk factor for poor outcomes; however, the significance of short term variations in blood glucose is poorly understood. The current study aimed to investigate if there is an independent association between preoperative glycemic variability and surgical-site infection and anastomosing complications. Methods: A prospective observational cohort of 312 patients with elective colorectal resection was created. The glycemic variability was measured using serial preoperative capillary and venous glucose measurements, using coefficient of variation and the mean amplitude of glycemic excursion as quantitative measurements. Patients were divided into low and high variability groups. Multivariable logistic regression that was adjusted for age, body mass index, diabetes status, glycated haemoglobin, tumour stage and operative approach. Results: 18.9% of the patients developed S-SI, and anastomotic complications were observed in 9.6%. HGV was independently associated with surgical-site infection and anastomotic complications; independent of mean glucose and glycated haemoglobin. Conclusion: Glycemic variability is an independent and potentially modifiable peri-operative risk factor for infective and anastomotic morbidity after elective CRC surgery and should be added to peri-operative risk assessment.

Keywords: Glycemic variability, Surgical-site infection, Anastomotic leak, Colorectal cancer, Perioperative glucose