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

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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.	杨子林, 徐惟, 许世广, 等. 机器人肺癌术后胸腔引流时间影响因素分析及应对策略. 中国胸心血管外科临床杂志, 2021, 28(5): 524-528.
6.	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版). 中华糖尿病杂志, 2018, 10(1): 4-67.
7.	段晓峰, 弓磊, 尚晓滨, 等食管鳞癌患者术前空腹血糖水平与术后并发症的相关性研究. 中华胃肠外科杂志, 2016, 19(9): 1004-1008.
8.	铁仝. 围手术期血糖控制对股骨粗隆间骨折股骨近端防旋髓内钉治疗效果的影响研究. 现代诊断与治疗, 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.	孙梦寒, 茆梦, 孙杰. 术前低白蛋白血症与肺切除术后肺部并发症的关系. 中华麻醉学杂志, 2020, 40(7): 795-799.
11.	陈春雨, 顾江魁, 葛圣林. 术前呼气峰流速对肺癌患者肺叶切除术后肺部并发症预测价值的研究. 天津医药, 2020, 48(2): 115-118.
12.	高宝, 杨志广, 刘韵鹏, 等. 老年患者肺切除术后肺部并发症的相关危险因素. 中国老年学杂志, 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.	曹钦光. 高龄肺癌合并2型糖尿病患者围手术期临床治疗效果观察. 糖尿病新世界, 2019, 22(13): 45-46.
21.	陈云, 王首亚, 张龙. 2型糖尿病合并急性肺炎病原菌分布及耐药情况分析. 检验医学与临床, 2021, 18(4): 531-533.
22.	傅方洁, 金丽媛, 董颖, 等. 2型糖尿病肺功能损害的相关机制及治疗进展. 医学综述, 2021, 27(8): 1596-1600.
23.	俞仙娇. 糖尿病合并难治性胸腔积液20例分析. 实用医学杂志, 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. 杨子林, 徐惟, 许世广, 等. 机器人肺癌术后胸腔引流时间影响因素分析及应对策略. 中国胸心血管外科临床杂志, 2021, 28(5): 524-528.
6. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版). 中华糖尿病杂志, 2018, 10(1): 4-67.
7. 段晓峰, 弓磊, 尚晓滨, 等食管鳞癌患者术前空腹血糖水平与术后并发症的相关性研究. 中华胃肠外科杂志, 2016, 19(9): 1004-1008.
8. 铁仝. 围手术期血糖控制对股骨粗隆间骨折股骨近端防旋髓内钉治疗效果的影响研究. 现代诊断与治疗, 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. 孙梦寒, 茆梦, 孙杰. 术前低白蛋白血症与肺切除术后肺部并发症的关系. 中华麻醉学杂志, 2020, 40(7): 795-799.
11. 陈春雨, 顾江魁, 葛圣林. 术前呼气峰流速对肺癌患者肺叶切除术后肺部并发症预测价值的研究. 天津医药, 2020, 48(2): 115-118.
12. 高宝, 杨志广, 刘韵鹏, 等. 老年患者肺切除术后肺部并发症的相关危险因素. 中国老年学杂志, 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. 曹钦光. 高龄肺癌合并2型糖尿病患者围手术期临床治疗效果观察. 糖尿病新世界, 2019, 22(13): 45-46.
21. 陈云, 王首亚, 张龙. 2型糖尿病合并急性肺炎病原菌分布及耐药情况分析. 检验医学与临床, 2021, 18(4): 531-533.
22. 傅方洁, 金丽媛, 董颖, 等. 2型糖尿病肺功能损害的相关机制及治疗进展. 医学综述, 2021, 27(8): 1596-1600.
23. 俞仙娇. 糖尿病合并难治性胸腔积液20例分析. 实用医学杂志, 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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