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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.23301    [Epub ahead of print]
Published online January 4, 2024.
Association of preoperative blood glucose level with delirium after non-cardiac surgery in diabetic patients
Soo Jung Park1,2  , Ah Ran Oh1,3  , Jong-Hwan Lee1  , Kwangmo Yang4  , Jungchan Park1 
1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
3Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
4Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding author:  Jungchan Park, Tel: +82-2-3410-3214, Fax: +82-2-3410-2849, 
Email: jc83.park@samsung.com
Received: 17 April 2023   • Revised: 15 December 2023   • Accepted: 3 January 2024
Abstract
Background
Hyperglycemia has shown a negative association with cognitive dysfunction. We analyzed patients with high preoperative blood glucose level and hemoglobin A1c (HbA1c) level to determine the prevalence of postoperative delirium.
Methods
We reviewed a database of 23,532 patients with diabetes who underwent non-cardiac surgery. Acute hyperglycemia was defined as fasting blood glucose > 140 mg/dl or random glucose > 180 mg/dl within 24 h before surgery. Chronic hyperglycemia was defined as HbA1c level above 6.5% within three months before surgery. The incidence of delirium was compared according to the presence of acute and chronic hyperglycemia.
Results
Of the 23,532 diabetic patients, 21,585 had available preoperative blood glucose level within 24 h before surgery, and 18,452 patients reported levels indicating acute hyperglycemia. Of the 8,927 patients with available HbA1c level within three months before surgery, 5,522 had levels indicating chronic hyperglycemia. After adjustment with inverse probability weighting, acute hyperglycemia was related to higher incidence of delirium (hazard ratio: 1.33, 95% CI [1.10,1.62], P = 0.004 for delirium) compared with controls without acute hyperglycemia. On the other hand, chronic hyperglycemia did not correlate with postoperative delirium.
Conclusions
Preoperative acute hyperglycemia was associated with postoperative delirium, whereas chronic hyperglycemia was not significantly associated with postoperative delirium. Irrespective of chronic hyperglycemia, acute glycemic control in surgical patients could be crucial for preventing postoperative delirium.
Key Words: Blood glucose; Cognitive dysfunction; Emergence delirium; Glycated hemoglobin; Hyperglycemia; Mortality; Postoperative delirium.


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