Nonalcoholic Fatty Liver Disease as a High-Value Predictor of Postoperative Hyperglycemia and Its Associated Complications in Major Abdominal Surgery

• Published in: Journal of the American College of Surgeons Vol. 227; no. 4; pp. 419 - 429.e6
• Main Authors: Ssentongo, Paddy, Ssentongo, Anna E., Dykes, Thomas, Pauli, Eric M., Soybel, David I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2018
• Subjects: Adult; Aged; Female; Hernia, Ventral - surgery; Herniorrhaphy - methods; Humans; Hyperglycemia - etiology; Intra-Abdominal Fat - diagnostic imaging; Male; Middle Aged; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Postoperative Complications - etiology; Predictive Value of Tests; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome; LOS; cVHR; OR; SSO-I; CMA; T2D; POHG; HbA1C; SSO; WCHR; ED
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2018.07.655

For patients undergoing major abdominal operations, acute postoperative hyperglycemia (POHG) is associated with suboptimal outcomes and higher costs of care. This study was performed to determine whether CT-derived indices of nonalcoholic fatty liver disease (hepatic steatosis) or visceral adiposity may serve as predictors of POHG and its consequences in such patients. We reviewed records and preoperative abdominal CT images of 129 patients undergoing complex open ventral hernia repair (cVHR) from 2012 to 2016, with 90-day follow-up. Univariate and multivariate regressions were performed to estimate associations between CT-detected steatosis or visceral adiposity with POHG (serum glucose > 140 mg/dL within 48 hours), surgical site occurrence (SSO), and subsequent interventions (SSO-I). Type-2 diabetes (T2D) was present in 23% and POHG in 52%; SSO events occurred in 28% and SSO-I in 21%. Highest-effect associations with POHG were observed for T2D (odds ratio [OR] 21.54; 95% CI 4.85, 95.58), hepatic steatosis (OR 2.20, 95% CI 1.07, 4.52), and waist circumference-to-height ratio (WCHR > 0.65; OR 2.37, 95% CI 1.16, 4.83). After multivariate analysis, the effects of T2D (OR 16.73; CI 5.42, 73.87; p < 0.0001) and steatosis (OR 2.55; CI 1.17, 5.69; p = 0.02) remained independently associated with POHG. Independent associations with SSO were observed for steatosis (OR 3.31; CI 1.41, 8.06; p = 0.007), POHG (OR 2.85; CI 1.17, 7.38; p = 0.024), and WCHR (OR 2.68; CI 1.11, 6.85; p = 0.03). Image-based indices of chronic metabolic disturbance in the liver and adipose tissues may offer novel opportunities for identifying patients at risk for POHG and those who would benefit from preoperative metabolic optimization.