Postoperative hyperglycemia, nutritional recovery, and diabetes duration as predictors of complications after colorectal cancer surgery.

PURPOSE: Postoperative complications continue to be a principal cause of morbidity following surgeries for colorectal cancer.

METHODS

This retrospective cohort study comprising 296 patients who underwent elective resections between 2014 and 2018 examined the influence of perioperative hyperglycemia, nutritional recovery, and the duration of diabetes on postoperative outcomes. Blood glucose levels were documented across the preoperative, intraoperative, and postoperative periods and categorized into four ranges (< 70, 70-119, 120-180, > 180 mg/dL). Nutritional recovery was characterized by the time to initial oral intake and resumption of a regular diet. Complications were classified using the Clavien-Dindo system, occurring in 14.5% of the cohort, with major complications (grades III-V) in 10.4% and a mortality rate of 0.3%.

RESULTS

The primary outcome of this study was the occurrence of complications classified as grade II or higher according to the Clavien-Dindo system, which served as the basis for all multivariable analyses. Postoperative hyperglycemia was correlated with a significantly increased rate of complications (26.3% vs. 14.0%, p = 0.049) and an extended duration of hospitalization (10.0 ± 4.0 vs. 7.0 ± 4.0 days, p < 0.001). Logistic regression analysis identified postoperative hyperglycemia (OR 2.10, 95% CI 1.15-3.85, p = 0.016) and a delayed transition to a regular diet (OR 1.95, 95% CI 1.02-3.72, p = 0.041) as independent predictors of complications of grade II or higher. Each additional year of diabetes duration was associated with a 10.4% increase in risk (OR 1.104, 95% CI 1.021-1.194, p = 0.012).

CONCLUSION

These results underscore the integral role of glycemic and nutritional considerations in influencing postoperative recovery. Incorporating postoperative hyperglycemia control, prompt nutritional recovery, and diabetes duration into perioperative risk assessment may optimize ERAS protocols and lessen morbidity in colorectal cancer surgical interventions.