Perioperative medicine & outcomes
Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis
An erratum to this article was published (Br J Anaesth, Apr 2024 ↗)
Authors' conclusion
These findings provide the first evidence that an anion gap acidosis, likely from ketoacids, develops in all patients who do not hold SGLT2 inhibitors before surgery rather than in an idiosyncratic few.
Study context
- Population
- Patients on SGLT2 inhibitors undergoing surgery at Massachusetts General Hospital, 2016–22
- Participants
- 463 patients
- Exposure
- Shorter vs longer preoperative SGLT2 inhibitor hold time
- Outcome
- Postoperative anion gap (controlling for non-ketone anions) by hold time
Methodological detailssingle-centre, multivariable regression
- Single-centre
- Multivariable regression
Main finding
As reported in the abstract
Postoperative anion gap by hold time
- Change in anion gap per day held (multivariable analysis)
- −0.43, 95% CI −0.76 to −0.11, P=0.01
- Association between decreased hold time and postoperative anion gap (univariable analysis)
- P<0.001
Observational data: associations, not effects.
Further findings
- Significant interaction between hold time and emergency surgery; no apparent interaction with insulin use or cardiac surgery
Original publication
Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis. Br J Anaesth. Published 2 August 2023. doi:10.
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