Effects of Perioperative Glycemic Control on Morbidity and Mortality Related to Surgery

Abstract

  Maintenance of the energy demand/supply balance is essential for an uneventful clinical course in patients undergoing surgery. Thus, adequate control of glucose metabolism in the perioperative period is definitely important. Recent studies suggest that hyperglycemia in the perioperative period is a risk factor for mortality and morbidity related to surgery, but a standard protocol for perioperative glycemic control has not been established. There are several factors that modify glucose metabolism in the perioperative period. Perioperative nutritional management alters glucose metabolism; for example, energy demand/supply imbalance associated with preoperative fasting results in remarkable changes in glucose metabolism. Surgical stress results in stress-induced hyperglycemia. Furthermore, intraoperative glucose metabolism is modified by anesthetic management. Aerobic glucose metabolism is not always guaranteed during surgery, since oxygen demand/supply imbalance induces anaerobic glucose metabolism. In addition, ischemia/reperfusion is accompanied by some kind of surgical procedure. The underlying mechanisms by which these factors modify glucose metabolism have not been sufficiently elucidated. Further studies are required to understand glucose metabolism in the perioperative period and to establish a standard protocol for perioperative glycemic control, which can contribute to improving surgical prognosis.