Using the Cambridge Risk Score to Predict New Hyperglycemia and Complications in Surgical Patients without Diabetes

Perioperative hyperglycemia is associated with adverse surgical outcomes and increased mortality, and when occurring in patients without history of diabetes, this is termed new hyperglycemia (NH). The Cambridge Risk Score (CRS) is a screening tool for type 2 diabetes that is associated with NH, yet its application in a surgical population has not been studied. Our study examined the association between CRS, NH, and complications in patients undergoing elective surgery. In this retrospective cross-sectional study of adult surgical patients admitted to a tertiary care center over 4 years, subjects with NH (blood glucose ≥140 mg/dL in nondiabetics) were identified, and the CRS was calculated. CRS, NH, and clinical outcomes were adjusted for race/ethnicity, payor type, and Elixhauser Comorbidity Index. Patients were stratified by surgery type (cardiac/vascular, general, orthopedic, and neurologic), and multivariate regression analyses assessed the association between CRS, NH, and clinical outcomes. Of 10,531 subjects included in the study, 24% developed NH. After adjusting for covariates, the CRS was significantly associated with the development of complications (odds ratio [OR], 2.09 [1.69, 2.59]; p<.001) and NH (OR, 1.95 [1.66, 2.29]; p<.001). When stratifying by surgery type, CRS was significantly associated with NH, length of stay, and complications in the neurosurgery and orthopedic surgery cohorts, but not cardiac/vascular or general surgery. NH, when adjusted for covariates, was associated with 30-day readmission rates (OR, 1.52 [1.23, 1.86]; p<.001) and length of stay (linear model estimate, 0.61 [0.57, 0.66]; p<.001), but not with complication outcomes. CRS was associated with the development of NH and complications in elective neurological and orthopedic surgery patients and could help identify high-risk surgical patients. Further study should evaluate if treatment of NH is associated with better outcomes in CRS high-risk patients. Disclosure H.Lee: None. P.J.Hartfield: None. G.Sinson: None. M.C.Wang: Consultant; Medtronic, Zimmer Biomet. A.Z.Dawson: None. A.Thorgerson: None. C.E.Mendez: Speaker's Bureau; Siemens.