Relationship between preoperative fasting plasma glucose and postoperative pulmonary complications after lung resection in type 2 diabetic patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZUO Jing , LIU Yuping , JIN Qiyan , FANG Qing , JING Guoqing , YANG Cheng , LI Xinyi , ZHANG Zongze , WANG Yanlin ,  SONG Xuemin

Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, P. R. China;

Corresponding?author：

SONG Xuemin, Email: sxmc11018@163.com

Keywords：

Pneumonectomy; preoperative fasting plasma glucose level; postoperative pulmonary complications; risk factors

DOI：

10.7507/1007-4848.202110051

Video：

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Objective To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.

Citation： ZUO Jing, LIU Yuping, JIN Qiyan, FANG Qing, JING Guoqing, YANG Cheng, LI Xinyi, ZHANG Zongze, WANG Yanlin, SONG Xuemin. Relationship between preoperative fasting plasma glucose and postoperative pulmonary complications after lung resection in type 2 diabetic patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(5): 683-689. doi: 10.7507/1007-4848.202110051 Copy

1.	Im Y, Park HY, Shin S, et al. Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer. Respir Res, 2019, 20(1): 136.
2.	Kim ES, Kim YT, Kang CH, et al. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD. Int J Chron Obstruct Pulmon Dis, 2016, 11: 1317-1326.
3.	Goodenough CJ, Liang MK, Nguyen MT, et al. Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery. J Am Coll Surg, 2015, 221(4): 854-861.
4.	Shewale JB, Corsini EM, Correa AM, et al. Time trends and predictors of survival in surgically resected early-stage non-small cell lung cancer patients. J Surg Oncol, 2020, 122(3): 495-505.
5.	楊子林, 徐惟, 許世廣, 等. 機器人肺癌術后胸腔引流時間影響因素分析及應對策略. 中國胸心血管外科臨床雜志, 2021, 28(5): 524-528.
6.	中華醫學會糖尿病學分會. 中國2型糖尿病防治指南(2017年版). 中華糖尿病雜志, 2018, 10(1): 4-67.
7.	段曉峰, 弓磊, 尚曉濱, 等食管鱗癌患者術前空腹血糖水平與術后并發癥的相關性研究. 中華胃腸外科雜志, 2016, 19(9): 1004-1008.
8.	鐵仝. 圍手術期血糖控制對股骨粗隆間骨折股骨近端防旋髓內釘治療效果的影響研究. 現代診斷與治療, 2018, 29(1): 125-126.
9.	Seok Y, Hong N, Lee E. Impact of smoking history on postoperative pulmonary complications: A review of recent lung cancer patients. Ann Thorac Cardiovasc Surg, 2014, 20(2): 123-128.
10.	孫夢寒, 茆夢, 孫杰. 術前低白蛋白血癥與肺切除術后肺部并發癥的關系. 中華麻醉學雜志, 2020, 40(7): 795-799.
11.	陳春雨, 顧江魁, 葛圣林. 術前呼氣峰流速對肺癌患者肺葉切除術后肺部并發癥預測價值的研究. 天津醫藥, 2020, 48(2): 115-118.
12.	高寶, 楊志廣, 劉韻鵬, 等. 老年患者肺切除術后肺部并發癥的相關危險因素. 中國老年學雜志, 2016, 36(20): 5085-5088.
13.	Fernandez FG, Falcoz PE, Kozower BD, et al. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. Ann Thorac Surg, 2015, 99(1): 368-376.
14.	Yang R, Wu Y, Yao L, et al. Risk factors of postoperative pulmonary complications after minimally invasive anatomic resection for lung cancer. Ther Clin Risk Manag, 2019, 15: 223-231.
15.	Wang Y, Hu X, Su MC, et al. Postoperative elevations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict postoperative pulmonary complications in non-small cell lung cancer patients: A retrospective cohort study. Curr Med Sci, 2020, 40(2): 339-347.
16.	Kanno H, Deguchi H, Tomoyasu M, et al. Prediction formula for predicted diffusion capacity of lung for carbon monoxide in pulmonary surgery. Gen Thorac Cardiovasc Surg, 2020, 68(12): 1432-1438.
17.	Zhang R, Kyriss T, Dippon J, et al. American Society of Anesthesiologists physical status facilitates risk stratification of elderly patients undergoing thoracoscopic lobectomy. Eur J Cardiothorac Surg, 2018, 53(5): 973-979.
18.	Dougherty SM, Schommer J, Salinas JL, et al. Immediate preoperative hyperglycemia correlates with complications in non-cardiac surgical cases. J Clin Anesth, 2021, 74: 110375.
19.	Kaseda K, Hishida T, Masai K, et al. Clinicopathological and prognostic features of operable non-small cell lung cancer patients with diabetes mellitus. J Surg Oncol, 2021, 123(1): 332-341.
20.	曹欽光. 高齡肺癌合并2型糖尿病患者圍手術期臨床治療效果觀察. 糖尿病新世界, 2019, 22(13): 45-46.
21.	陳云, 王首亞, 張龍. 2型糖尿病合并急性肺炎病原菌分布及耐藥情況分析. 檢驗醫學與臨床, 2021, 18(4): 531-533.
22.	傅方潔, 金麗媛, 董穎, 等. 2型糖尿病肺功能損害的相關機制及治療進展. 醫學綜述, 2021, 27(8): 1596-1600.
23.	俞仙嬌. 糖尿病合并難治性胸腔積液20例分析. 實用醫學雜志, 2013, 29: 511.

1. Im Y, Park HY, Shin S, et al. Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer. Respir Res, 2019, 20(1): 136.
2. Kim ES, Kim YT, Kang CH, et al. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD. Int J Chron Obstruct Pulmon Dis, 2016, 11: 1317-1326.
3. Goodenough CJ, Liang MK, Nguyen MT, et al. Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery. J Am Coll Surg, 2015, 221(4): 854-861.
4. Shewale JB, Corsini EM, Correa AM, et al. Time trends and predictors of survival in surgically resected early-stage non-small cell lung cancer patients. J Surg Oncol, 2020, 122(3): 495-505.
5. 楊子林, 徐惟, 許世廣, 等. 機器人肺癌術后胸腔引流時間影響因素分析及應對策略. 中國胸心血管外科臨床雜志, 2021, 28(5): 524-528.
6. 中華醫學會糖尿病學分會. 中國2型糖尿病防治指南(2017年版). 中華糖尿病雜志, 2018, 10(1): 4-67.
7. 段曉峰, 弓磊, 尚曉濱, 等食管鱗癌患者術前空腹血糖水平與術后并發癥的相關性研究. 中華胃腸外科雜志, 2016, 19(9): 1004-1008.
8. 鐵仝. 圍手術期血糖控制對股骨粗隆間骨折股骨近端防旋髓內釘治療效果的影響研究. 現代診斷與治療, 2018, 29(1): 125-126.
9. Seok Y, Hong N, Lee E. Impact of smoking history on postoperative pulmonary complications: A review of recent lung cancer patients. Ann Thorac Cardiovasc Surg, 2014, 20(2): 123-128.
10. 孫夢寒, 茆夢, 孫杰. 術前低白蛋白血癥與肺切除術后肺部并發癥的關系. 中華麻醉學雜志, 2020, 40(7): 795-799.
11. 陳春雨, 顧江魁, 葛圣林. 術前呼氣峰流速對肺癌患者肺葉切除術后肺部并發癥預測價值的研究. 天津醫藥, 2020, 48(2): 115-118.
12. 高寶, 楊志廣, 劉韻鵬, 等. 老年患者肺切除術后肺部并發癥的相關危險因素. 中國老年學雜志, 2016, 36(20): 5085-5088.
13. Fernandez FG, Falcoz PE, Kozower BD, et al. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. Ann Thorac Surg, 2015, 99(1): 368-376.
14. Yang R, Wu Y, Yao L, et al. Risk factors of postoperative pulmonary complications after minimally invasive anatomic resection for lung cancer. Ther Clin Risk Manag, 2019, 15: 223-231.
15. Wang Y, Hu X, Su MC, et al. Postoperative elevations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict postoperative pulmonary complications in non-small cell lung cancer patients: A retrospective cohort study. Curr Med Sci, 2020, 40(2): 339-347.
16. Kanno H, Deguchi H, Tomoyasu M, et al. Prediction formula for predicted diffusion capacity of lung for carbon monoxide in pulmonary surgery. Gen Thorac Cardiovasc Surg, 2020, 68(12): 1432-1438.
17. Zhang R, Kyriss T, Dippon J, et al. American Society of Anesthesiologists physical status facilitates risk stratification of elderly patients undergoing thoracoscopic lobectomy. Eur J Cardiothorac Surg, 2018, 53(5): 973-979.
18. Dougherty SM, Schommer J, Salinas JL, et al. Immediate preoperative hyperglycemia correlates with complications in non-cardiac surgical cases. J Clin Anesth, 2021, 74: 110375.
19. Kaseda K, Hishida T, Masai K, et al. Clinicopathological and prognostic features of operable non-small cell lung cancer patients with diabetes mellitus. J Surg Oncol, 2021, 123(1): 332-341.
20. 曹欽光. 高齡肺癌合并2型糖尿病患者圍手術期臨床治療效果觀察. 糖尿病新世界, 2019, 22(13): 45-46.
21. 陳云, 王首亞, 張龍. 2型糖尿病合并急性肺炎病原菌分布及耐藥情況分析. 檢驗醫學與臨床, 2021, 18(4): 531-533.
22. 傅方潔, 金麗媛, 董穎, 等. 2型糖尿病肺功能損害的相關機制及治療進展. 醫學綜述, 2021, 27(8): 1596-1600.
23. 俞仙嬌. 糖尿病合并難治性胸腔積液20例分析. 實用醫學雜志, 2013, 29: 511.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between preoperative fasting plasma glucose and postoperative pulmonary complications after lung resection in type 2 diabetic patients

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