RT Book, Section A1 Cheng, Hugo Q. A2 Papadakis, Maxine A. A2 McPhee, Stephen J. A2 Rabow, Michael W. A2 McQuaid, Kenneth R. SR Print(0) ID 1184156219 T1 Perioperative Management of Endocrine Diseases T2 Current Medical Diagnosis & Treatment 2022 YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781264269389 LK accessmedicine.mhmedical.com/content.aspx?aid=1184156219 RD 2024/03/28 AB Poor preoperative glycemic control, as indicated by an elevated hemoglobin A1c level, is associated with a greater risk of surgical complications, particularly infections. However, a strategy of delaying surgery until glycemic control improves has not been rigorously studied. The ideal postoperative blood glucose target is also unknown. Trials have demonstrated that tighter perioperative glycemic control leads to better clinical outcomes in cardiac surgery patients in a critical care unit. This finding is not generally applicable to other surgical patients, however, since a subsequent trial demonstrated increased mortality with tight control in surgical patients in an intensive care unit. Data are lacking on risks and benefits of tight control in patients outside of intensive care units. Based on trials that showed increased mortality in hospitalized patients randomized to tight control, the American College of Physicians recommends maintaining serum glucose between 140 mg/dL and 200 mg/dL (7.8–11.1 mmol/L), whereas the British National Health Service guidelines recommend a range of 108–180 mg/dL (6–10 mmol/L). Even for coronary artery bypass patients, the Society of Thoracic Surgeons recommends a blood glucose range of 121–180 mg/dL (6.7–10 mmol/L).