key: cord-0844165-dx8sesyw
authors: Farahani, Farhad; Mirzaei, Fatemeh; Khodadadi, Iraj; Abbasi-Oshaghi, Ebrahim
title: Importance of hyperglycemia in preoperative, intraoperative and postoperative periods in COVID-19 patients
date: 2020-09-11
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.08.048
sha: 9f6e1dbb5a7e7c5a976c27e9d64d221f558f5d7e
doc_id: 844165
cord_uid: dx8sesyw

nan

Dear Editor, Diabetes and hypertension are the most common comorbidities associated with poor prognosis in Coronavirus disease 2019 (COVID-19) patients [1] . Hyperglycemia is recognized as an independent predictor of mortality in COVID-19 cases, indicating the importance of addressing high blood glucose levels. Numerous factors especially inflammation, impaired immune response, decreased intracellular bactericidal activity, and elevated risk of lung disease contribute to increased disease severity. Therefore, management of glucose levels in COVID-19 patients is essential. Studies showed that about one-third of patients who were admitted to hospitals without any history of diabetes have hyperglycemia, which increased the hospital length of stay, surgical site infections (SSI), ICU admission rates, and increase morbidity/mortality rates. In surgical cases, perioperative hyperglycemia elevates lung failure, neurologic disorders, cardiovascular morbidity, and postoperative mortality rates [2] .

Hyperglycemia in hospitals commonly occurs in patients with acute trauma, viral infection, septicemia, burns, myocardial infarction, stroke, and cardiac surgery [3] .

Hyperglycemia is related with the risk of atrial fibrillation, infection, cardiovascular diseases, myocardial infarction, pericarditis, cerebral ischemia, impaired wound healing , as well as respiratory and neurologic complications [4] . It has been reported that 20-40% of patients undergoing general surgery and nearly 80% of patients after cardiac surgery experienced perioperative hyperglycemia [4] . Hyperglycemic patients are more susceptible to surgical and other nosocomial infections [3] . The stress of anesthesia and surgery results in change of endogenous hormone secretion (e.g., elevated catecholamines, cortisol, growth hormone, and glucagon), inflammatory reaction, and subsequent hyperglycemia and inflammation [4] . It has been established that postoperative SSI is a well-known cause of death worldwide. In surgery patients, SSI is the most common hospital infection (about 38%) [3] .

In the below section we summarizes the key points and recommendations for management of hyperglycaemia in preoperative, intraoperative and postoperative periods [2] [3] [4] . 

Diagnosis and treatment of coronavirus disease 2019 (COVID-19): Laboratory, PCR, and chest CT imaging findings

Stress hyperglycemia and surgical site infection in stable nondiabetic adults with orthopedic injuries

Postoperative hyperglycemia and surgical site infection in general surgery patients

Perioperative Hyperglycemia Management: An Update

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