Preoperative Carbohydrate Load Does Not Alter Glycemic Variability in Diabetic and Non-Diabetic Patients Undergoing Major Gynecological Surgery: A Retrospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Outcome Measures
2.3. Statistical Analysis
- α = probability of a type one error, chosen to be 0.05;
- β = the power of the test, chosen to be 0.80 or 0.90;
- = the variance of the populations, estimated here by the pooled variance with data from the retrospective study;
- ○
- d = the desired effect size, in this case 10%.
3. Results
3.1. Baseline Characteristics
3.2. Anesthetic Type
3.3. Glucose Homeostasis
3.4. Secondary Outcomes
3.5. Subgroup Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Perioperative ERAS Checklist: Gynecologic and Gyn-Oncologic Surgery
ERAS: PONV Screening Tool | ||||
STEP 1 | How many PONV risk factors present? | |||
SCREENING | ||||
PONV Risk Factors | Points | |||
History of PONV | 1 | |||
Motion sickness | 1 | |||
Female gender | 1 | |||
Non-smoker | 1 | |||
Age <50 years | 1 | |||
Use of opioids in PACU expected | 1 | |||
Total: | 6 | |||
STEP 2 | Use preop PONV risk factors to select PONV prophylaxis? | |||
PONV RISK STRATIFICATION AND PROPHYLAXIS | ||||
Total PONV Risk Factors | 0–1 | 2 | 3 | ≥4 |
PONV Risk Level | Minimal | Low | Moderate | High |
PONV prophylaxis | ----- | Dexamethasone (4 mg) | Scopolamine (1.5 mg patch, preop) + Dexamethasone (4 mg) | Scopolamine (1.5 mg patch, preop) + Dexamethasone (4 mg) + Ondansetron (4 mg) |
Appendix B. Surgery Types/CPT Codes Included in Dataset
total abdominal hysterectomy | 58150, 58152, 58200, 58210, 58240 |
total vaginal hysterectomy | 58260–58294 |
lap-assisted vaginal hysterectomy | 58550–58554 |
total laparoscopic hysterectomy | 58541–58544, 58570–58573, 58575 |
supracervical hysterectomy | 58180 |
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Data | Control (n = 45) | Intervention (n = 63) | p-Value |
---|---|---|---|
Age (years) | 54.4 | 52.6 | 0.45 |
Race | 0.59 | ||
White (%) | 11 (24.4%) | 13 (20.6%) | |
African American (%) | 22 (48.9%) | 27 (42.9%) | |
Hispanic or Latino (%) | 6 (13.3%) | 11 (17.5%) | |
Asian (%) | 2 (4.4%) | 1 (1.6%) | |
Not Available (%) | 4 (8.9%) | 11 (17.5%) | |
Comorbidities | |||
Hypertension (%) | 30 (66.7%) | 32 (50.8%) | 0.15 |
Diabetes Mellitus (%) | 29 (64.4%) | 29 (46.0%) | 0.09 |
Body Mass Index (unit) | 33.8 | 32.6 | 0.40 |
ASA Physical Status Classification | 0.19 | ||
I | 1 (2.2%) | 0 (0%) | |
II | 23 (51.1%) | 42 (67.7%) | |
III | 20 (44.4%) | 19 (30.6%) | |
IV | 1 (2.2%) | 1 (1.6%) | |
Anesthetic Type | <0.001 | ||
TIVA | 2 (4.4%) | 5 (7.9%) | |
Sevoflurane | 36 (80.0%) | 20 (31.7%) | |
Propofol + Sevoflurane | 7 (15.6%) | 38 (60.3%) |
Variable | No PCL (n = 45) | PCL (n = 63) | p-Value |
---|---|---|---|
Mean BGC (mg/dL) | 158.4 | 152.6 | 0.48 |
Standard Deviation | 29.6 | 29.3 | 0.91 |
CV (%) | 18.6 | 19.3 | 0.65 |
GLI | 0.54 | 0.58 | 0.86 |
PACU Pain Score | 5.2 | 4.5 | 0.23 |
PACU IS (mL) | 1245 | 1262 | 0.87 |
No PCL (n = 45) | PCL (n = 63) | p-Value | |
---|---|---|---|
DM Mean BGC (mg/dL) | 168.5 | 171.5 | 0.77 |
DM CV (%) | 17.8 | 19.3 | 0.49 |
DM GLI | 0.65 | 1.08 | 0.34 |
Non-DM Mean BGC (mg/dL) | 140.2 | 136.5 | 0.76 |
Non-DM CV (%) | 20.0 | 19.4 | 0.85 |
Non-DM GLI | 0.33 | 0.15 | 0.35 |
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Canelli, R.; Louca, J.; Gonzalez, M.; Sia, M.; Baker, M.B.; Varghese, S.; Dienes, E.; Bilotta, F. Preoperative Carbohydrate Load Does Not Alter Glycemic Variability in Diabetic and Non-Diabetic Patients Undergoing Major Gynecological Surgery: A Retrospective Study. J. Clin. Med. 2024, 13, 4704. https://doi.org/10.3390/jcm13164704
Canelli R, Louca J, Gonzalez M, Sia M, Baker MB, Varghese S, Dienes E, Bilotta F. Preoperative Carbohydrate Load Does Not Alter Glycemic Variability in Diabetic and Non-Diabetic Patients Undergoing Major Gynecological Surgery: A Retrospective Study. Journal of Clinical Medicine. 2024; 13(16):4704. https://doi.org/10.3390/jcm13164704
Chicago/Turabian StyleCanelli, Robert, Joseph Louca, Mauricio Gonzalez, Michelle Sia, Maxwell B. Baker, Shama Varghese, Erin Dienes, and Federico Bilotta. 2024. "Preoperative Carbohydrate Load Does Not Alter Glycemic Variability in Diabetic and Non-Diabetic Patients Undergoing Major Gynecological Surgery: A Retrospective Study" Journal of Clinical Medicine 13, no. 16: 4704. https://doi.org/10.3390/jcm13164704