Hepatic clamping and postoperative hyperglycaemia: A retrospective cohort study in liver surgery.

BACKGROUND: The Pringle manoeuvre, which involves intermittent clamping of the hepatic pedicle, is a common surgical strategy employed to reduce blood loss during liver resection. Although its impact on intra-operative glucose levels has been documented, its contribution to postoperative hyperglycaemia remained an untested hypothesis. OBJECTIVES: The primary aim of this study was to determine whether hepatic vascular clamping was associated with increased postoperative hyperglycaemia within 24 h after liver surgery. Secondary aims included examining the association between postoperative hyperglycaemia and infectious complications and length of hospital stay. DESIGN: A retrospective observational cohort study. SETTING: Single tertiary university hospital. The study period extended from January 2020 to June 2022. PATIENTS: The study sample comprised 163 adult patients who underwent elective liver resection. Patients were grouped according to the intra-operative use of the Pringle manoeuvre: 107 patients underwent clamping (Pringle group), while 56 patients did not undergo clamping (No-Pringle group). No patients were excluded, and data were complete for all individuals included. MAIN OUTCOME MEASURES: The primary outcome was the occurrence of postoperative hyperglycaemia, defined as blood glucose at least 10.0 mmol l-1 (180 mg dl-1) within 24 h after surgery. Secondary outcomes included postoperative infectious complications and length of hospital stay. RESULTS: Postoperative hyperglycaemia occurred in 55.1% of patients in the Pringle group compared to 23.2% in the No-Pringle group (P < 0.001). Hepatic clamping was independently associated with postoperative hyperglycaemia (adjusted odds ratio 2.91, 95% confidence interval 1.06 to 8.92). As secondary findings, a higher incidence of postoperative infections was observed in the Pringle group (23.4 vs. 5.4%, P = 0.007), and the median hospital length of stay was longer (4 [2 to 8] vs. 2 [1 to 6] days, P = 0.003). CONCLUSIONS: The Pringle manoeuvre was associated with increased postoperative hyperglycaemia within 24 h after liver surgery. These findings underscore the necessity for proactive intra-operative and postoperative glucose control strategies as an integral component of peri-operative management in hepatic surgery.