Effect Of Diabetic Hyperglycemia And Obesity On The Condition Of Patients Undergoing Closed Biliary Surgery

Objective:The purpose of this study was to investigate the effects of different blood glucose and BMI levels in diabetic patients on the condition of patients undergoing closed biliary surgery,and to provide evidence for rational individual control of blood glucose and body weight.Methods:424 diabetic patients admitted to Shanxi Provincial People's Hospital for closed biliary tract surgery from January 2018 to June 2019 were recalled.The clinical data including age,sex,BMI,name of operation,general biochemical index(fasting blood glucose,HBA1C,low-density lipoprotein,total cholesterol,triglyceride,serum albumin,blood creatinine and urea nitrogen),admission to ICU,infection after operation,use of hypoglycemic drugs,blood glucose monitoring rate,HbA1C detection rate,length of hospitalization and hospitalization expenses were collected.According to the fasting blood glucose level,the subjects were divided into hyperglycemia group with FBG?7.0mmol/L and non-hyperglycemia group with FBG<7.0mmol/L,further,according to the BMI level,the patients were divided into obese subgroup with BMI?25kg/m~2 and non-obese Subgroup with BMI<25kg/m~2.The differences of clinical data among different groups were compared and analyzed,the influencing factors of postoperative infection,length of stay and cost were analyzed by multiple regression analysis.Results:Compared to the non-hyperglycemia group,BMI,hospitalization days and total hospitalization expenses,FBG,serum creatinine,blood urea nitrogen,low albumin,blood glucose monitoring rate,HbA1C detection rate,hypoglycemic drug utilization rate,postoperative infection and ICU occupancy rates of the hyperglycemia group are high,the differences were statistically significant(P<0.05 or P<0.01);The level of albumin was low and the difference was statistically significant(P<0.01).In the hyperglycemia group,the age,BMI,FBG,serum creatinine,low-density lipoprotein,length of hospitalization and total hospitalization expenses of the obese subgroup were lower than those of the non-obese subgroup,with statistically significant differences(P<0.05 or P<0.01).In the non-hyperglycemia group,the BMI and Serum creatinine of the obese subgroup were higher than those of the non-obese subgroup,and the age was lower than that of the non-obese subgroup,with statistically significant differences(P<0.05 or P<0.01),but the remaining indicators had not statistically significant differences(P>0.05).Logistic regression analysis showed that hyperglycemia was an independent risk factor for postoperative infection,and for every 1 mmol/L increase in blood glucose,the risk of postoperative infection increased by 1.158x,while serum albumin was a protective factor for postoperative infection.Hyperglycemia,hypoalbuminemia,use of hypoglycemic agents,admission to the ICU,postoperative infection,and glucose monitoring were all associated with longer hospital stay and increased hospital costs,according to the regression analysis,age,obesity,serum creatinine,and urea nitrogen were associated with increased hospitalization costs,with statistically significant differences(P<0.05 or P<0.01).Conclusion:Hyperglycemia is an independent risk factor for postoperative infection,and is an independent correlation factor for prolonged hospital stay and increased hospital costs.Obesity was not associated with the incidence of postoperative infection and the length of hospital stay except to increase serum creatinine in non-hyperglycemia patients.For diabetic patients receiving closed biliary surgery,it is necessary to control blood glucose reasonably,improve the detection rate of glycosylated hemoglobin and blood glucose monitoring rate,and avoid hypoglycemia.At the same time,in order to control the blood glucose well,we still need to control the body weight properly.