Post-surgical DKA stems from poor glycemic control prior to surgery and perioperative catecholamine usage: unmatched case–control study

Surgery is a well-known trigger of Diabetes Ketoacidosis, DKA. Post-surgical DKA is poorly studied in the current literature. This study investigated post-surgical DKA association with poor glycemic control before surgery. Unmatched case–control study sampling all post-surgical DKA cases admitted to ICU during the period from 1st of March 2019 to 1st of December 2022 in King Saud Medical City, Riyadh, Saudi Arabia. The control group comprises all other adult post-surgical subjects admitted to ICU without DKA during the same period. Poor glycemic control was considered when the glycosylated hemoglobin, HbA1C, was equal to or more than 7%. Details of surgery were collected from patients’ records. Fifty-seven post-surgical DKA cases were included and the control group consists of 114 subjects. Poor glycemic control was more frequent among postoperative DKA cases with a statistically significant difference (OR 48.2 95% CI: 12.1 – 267.4; p value < 0.001). Sensitivity analysis of fifty-four pairs of cases and controls matched for age and sex had odds ratio of 48.6 (95% CI: 12.1 – 267.4, p < 0.001). Multivariable logistic regression was done for independent predictor of postoperative DKA. Intraoperative catecholamine and insulin usage along with prolonged duration of surgery were statistically significant predictors (p values < 0.05). Post-surgical DKA was ascribed to poor glycemic control. The usage of catecholamine during surgery associated with postsurgical DKA and should be considered in future research.