Intraoperative tight blood glucose control reduces the incidence of postoperative pneumonia in minimally invasive esophagectomy: a randomized clinical trial.

Background: Postoperative pneumonia is a common and fatal complication in minimally invasive esophagectomy patients and is related to perioperative blood glucose. This study hypothesized that compared to dealing with intraoperative blood glucose routinely, tight blood glucose control can reduce the incidence of postoperative pneumonia in minimally invasive esophagectomy patients.

Methods: In this randomized single- blind trial, 88 patients were randomly assigned (1:1) to the tight blood glucose control (4.4-6.1 mmol/L) or non-tight blood glucose control (blood glucose under 10 mmol/L). The primary outcome was the incidence of postoperative pneumonia. The intraoperative insulin-related complications, postoperative inflammation level, blood glucose level, surgical complications, and other secondary outcomes were also assessed.

Results: In total, 88 patients were randomized, and 84 patients were included in the analysis. The intention-to-treat analysis showed the incidence of postoperative pneumonia in the tight blood glucose control group (5 of 44 [11.4%]) was significantly lower than non-tight blood glucose control group (15 of 44 [34.1%]) (OR = 0.569, 95% CI: 0.39 to 0.83, P =  0.011). The C-reactive protein on postoperative day 1 was 78.3 (30.4-103.7) in the tight blood glucose control group and 95.6 (79.0-130.5) in the non-tight blood glucose control group (P =  0.008). Compared to the non-tight blood glucose control group (36 of 43 [83.7%]), the demand for advanced antibiotics was lower in the tight blood glucose control group (26 of 41 [63.4%]) (P =  0.034).

Conclusion: Intraoperative tight blood glucose control is beneficial in reducing the incidence of postoperative pneumonia for minimally invasive esophagectomy patients.

Registration: Chinese Clinical Trial Registry ChiCTR2300077993.