Association between preoperative hyperglycemia and adverse cardiac events after non-cardiac surgery: a multicenter cohort study

Background: We conducted a multicenter cohort study to evaluate whether preoperative acute hyperglycemia is associated with postoperative adverse cardiac events. Methods: Data from 10 hospitals were converted to the Observational Medical Outcomes Partnership Common Data Model and analyzed. We extracted the records of 318 119 adult patients who underwent non-cardiac surgery and had available blood glucose measurements less than 24 hours before surgery. We defined acute hyperglycemia as at least one fasting blood glucose measurement > 140 mg/dl or random blood glucose level measurement > 180 mg/dl < 24 hours before surgery. Risk of adverse cardiac events during the first year after surgery was analyzed. Results: After 1:2 propensity score matching, 40 340 patients with acute hyperglycemia and 70 770 patients without hyperglycemia were enrolled. Acute hyperglycemia was associated with an increased risk of adverse cardiac events (hazard ratio [HR]: 1.26, 95% CI [1.16–1.36], P < 0.001). In the subgroup analyses, the young age group (≤ 65 years) had a significantly higher risk (HR: 1.61, 95% CI [1.40–1.85]) than the older age group (HR: 1.13, 95% CI [1.03–1.25]; P for interaction < 0.001). A greater adverse cardiac events risk was observed in patients without hypertension (HR: 1.37, 95% CI [1.24–1.52]) but not in those with hypertension (HR: 1.09, 95% CI [0.96–1.22]; P for interaction = 0.003). Conclusions: Preoperative acute hyperglycemia was associated with adverse cardiac events during one year of follow up. Further investigation is warranted to determine whether acute glycemic control before non-cardiac surgery could prevent perioperative cardiac complications.