Preoperative hyperglycemia and postoperative adverse events in geriatric hip fracture surgery: Glycemic thresholds and exposure persistence.

BACKGROUND

Preoperative blood glucose levels are closely related to the occurrence of postoperative adverse events for geriatric patients undergoing surgery for hip fracture. However, the specific association between preoperative blood glucose levels and postoperative pressure ulcers (PU), postoperative delirium (POD), and prolonged length of stay (LOS) requires further investigation.

METHODS

This retrospective cohort study included hip fracture patients from 2017 to 2024. Preoperative blood glucose levels were analyzed both as a continuous variable and as a categorical variable to examine their association with postoperative PU, POD, and LOS. Statistical analyses were conducted using multivariable logistic regression, propensity score matching analysis and generalized linear models.

RESULTS

The results showed that for each 1 mmol/L increase in preoperative blood glucose, the risk of developing postoperative pressure ulcers and delirium increased by 21 % and 28 %, respectively, while hospital stay was prolonged by 0.54 days. Notably, in subgroups of male patients, those aged 70-79 years, those with no prior history of hypertension or delirium, those with surgical time ≥ 1.6 h, and those with time from admission to surgery >5 days, the positive correlation between preoperative blood glucose levels and PU and POD was even stronger. When preoperative blood glucose levels exceeded 6.09 mmol/L (for PU and LOS) and 6.17 mmol/L (for POD), timely intervention became crucial.

CONCLUSIONS

Preoperative hyperglycemia is significantly associated with postoperative PU, POD, and LOS in geriatric patients undergoing surgery for hip fracture. Early intervention, particularly glucose management for specific high-risk groups, may help reduce the incidence of adverse events.