Risk factors for perioperative hyperglycemia in Stanford type A acute aortic dissection

Objective To analyze the independent risk factors and complications for perioperative hyperglycemia in Stanford type A acute aortic dissection undergoing emergency operation and investigate the management strategy of perioperative blood glucose. Methods Between January 2010 and January 2015 from the department of great vessel surgery of Zhengzhou University People's Hospital, 195 cases of patients with Stanford type A acute aortic dissection undergoing emergency operation were collected consecutively, 130 male and 65 female. The related data and perioperative peak blood glucose were recorded. According to the perioperative peak blood glucose, patients were divided into 2 groups: ≥13.32 mmol/L group and <13.32 mmol/L group. Univariate and logistic regression analysis were used to identify the independent risk factors. The perioperative complications 1 were also recorded. Results Preoperative severe stress reaction(WBC: OR=2.343, 95%CI: 1.198-3.564, P=0.021; CRP: OR=2.459, 95%CI: 1.265-3.766, P=0.016), body mass index(OR=4.112, 95%CI: 1.346-6.121, P=0.009), diabetes mellitus(OR=4.766, 95%CI: 1.589-6.887, P=0.002), circulatory arrest time(OR=1.989, 95%CI: 0.983-2.451, P=0.032)were the independent risk factors for perioperative hyperglycemia. The incidence rate of postoperative lung infection[31(25.8%)vs. 10(13.3%), P=0.037]and acute lung injury[43(35.8%)vs. 15(22.7%), P=0.019], as well as tracheotomy[13(10.8%)vs. 2(2.7%), P=0.037]in ≥13.32 mmol/L group were significantly increased. Acute kidney injury[32(26.7%)vs. 10(13.3%), P=0.028]and CRRT usage[26(21.7%)vs. 7(9.3%), P=0.025]in≥13.32 mmol/L group were significantly increased. The duration of mechanical ventilation[(3.8±1.3)days vs.(2.1±0.7)days, P<0.001]and ICU stay time[(7.1±3.5)days vs(5.6±1.9)days, P<0.001]and hospitalization time[(29±7)days vs.(23±3)days, P<0.001]were significantly prolonged. Transient neurologic dysfunction[87(72.5%)vs 38(50.7%), P=0.002]and in-hospital mortality[22(18.3%)vs 6(8.0%), P=0.045]were significantly increased. Conclusion Preoperative severe stress reaction, body mass index, diabetes mellitus, circulatory arrest time were the independent risk factors for perioperative hyperglycemia in Stanford type A acute aortic dissection. The perioperative complications in ≥13.32 mmol/L group were significantly increased. Therefore, more attention should be paid to the independent risk factors for perioperative hyperglycemia in Stanford type A acute aortic dissection, the perioprative blood glucose level shoud be controlled more positively and smoothly. Key words: Aortic dissection; Deep hypothermic circulatory arrest; Perioperative care; Hyperglycemia