Analysis Of Risk Factors Of Hyperglycemia After Radical Gastrectomy For Gastric Cancer And Its Influence On Prognosis

Objective: Retrospectively analyze the risk factors of postoperative hyperglycemia and the impact of postoperative hyperglycemia on the prognosis of patients undergoing radical gastrectomy for gastric cancer to provide evidence for postoperative hyperglycemia risk assessment and improvement of postoperative prognosis.Methods: The clinical data of patients who were diagnosed with “gastric cancer” and underwent radical gastric cancer surgery in the First Affiliated Hospital of Guangxi Medical University from October 2018 to October 2020 were collected.The study subjects were selected according to the inclusions and exclusions criteria,and the included cases were divided into hyperglycemia group and non-hyperglycemia group referring to the diagnostic criteria of postoperative hyperglycemia.A retrospectively analysis method was used for the included cases to compare the preoperative general data,anesthesia and surgical data,and the prognosis data during the postoperative hospitalization of the two groups of patients.The clinical data of the included cases were analyzed retrospectively.The risk factors for postoperative hyperglycemia and the prognosis of postoperative hyperglycemia were analyzed.The ROC curve is used to evaluate the predictive power of postoperative hyperglycemia on postoperative complications.Results: 1.A total of 416 case were included in the study,including 143 cases of hyperglycemia(34.375%,hyperglycemia group)and 273 cases of normal blood sugar(65.625%,non-hyperglycemia group).2.After comparing the preoperative general and surgical data of the hyperglycemia group and the non-hyperglycemia group,it was found that there were statistically significant differences in the age,BMI,diabetes,method of anesthesia,operation duration,blood loss,preoperative fasting blood glucose,intraoperative average blood glucose,PACU blood glucose,and hyperglycemia during anesthesia(P<0.05);while the gender,ASA classification,surgical methods,laparoscopic surgery laparotomy,fluid infusion,blood transfusion and using glucocorticoids during operation were no significant difference(P>0.05).3.The univariate regression analysis of postoperative hyperglycemia showed: age ≥60 years old,diabetes,simple general anesthesia,operation duration ≥300 min,infusion volume ≥2500 ml,blood loss ≥200 ml,preoperative fasting blood glucose ≥6.1 mmol/L,hyperglycemia during anesthesia were statistically significant(P<0.05).Multivariate Logistic regression analysis of postoperative hyperglycemia found that age ≥60 years old(OR:1.814,95CI%:1.163-2.829,P=0.009),diabetes(OR:4.390;95CI%:1.133-17.013,P=0.032),simple general anesthesia(OR:1.833;95CI%:1.168-2.878,P=0.008),and hyperglycemia during anesthesia(OR:3.246;95CI%:1.845-5.712,P<0.001)are independent risk factors for postoperative hyperglycemia.4.The incidence of postoperative complications,hospitalization days,postoperative days to discharge and hospitalization expenses in the hyperglycemia group are higher than those in the non-hyperglycemia group(36.36% vs 11.72%,18.07±11.65 d vs 15.61±9.23 d,11.78±10.47 d vs 9.40±8.12 d,87581.72±42251.77 RMB vs 79817.70±30732.42 RMB,P<0.05).5.Postoperative hyperglycemia is an independent risk factor for postoperative complications(OR: 2.857,95%CI:1.664-4.907,P<0.001).The ROC curve confirms that postoperative hyperglycemia has predictive value for the occurrence of postoperative complications(AUC:0.704,sensitivity:71.9%,specificity:63%).Conclusions: Among patients undergoing radical gastrectomy,age ≥60years old,diabetes,simple general anesthesia and hyperglycemia during anesthesia are independent risk factors for postoperative hyperglycemia.Postoperative hyperglycemia is an independent risk factor for postoperative complications and postoperative hyperglycemia has predictive value for the occurrence of postoperative complications,patients with postoperative hyperglycemia have prolonged hospitalization days and increased hospital costs.