Abstract
The impact of diabetes on perioperative outcomes remains incompletely understood. Our purpose is to evaluate post-operative complications and mortality in patients with diabetes. Using the institutional and clinical databases of three university hospitals from 2009–2015, we conducted a matched study of 16,539 diabetes patients, aged >20 years, who underwent major surgery. Using a propensity score matching procedure, 16,539 surgical patients without diabetes who underwent surgery were also selected. Logistic regressions were used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for post-operative complications and in-hospital mortality associated with diabetes. Patients with diabetes had a higher risk of postoperative septicemia (OR 1.33, 95% CI 1.01–1.74), necrotizing fasciitis (OR 3.98, 95% CI 1.12–14.2), cellulitis (OR 2.10, 95% CI 1.46–3.03), acute pyelonephritis (OR 1.86, 95% CI 1.01–3.41), infectious arthritis (OR 3.89, 95% CI 1.19–12.7), and in-hospital mortality (OR 1.51, 95% CI 1.07–2.13) compared to people without diabetes. Previous admission for diabetes (OR 2.33, 95% CI 1.85–2.93), HbA1c >8% (OR 1.96, 95% CI 1.64–2.33) and fasting glucose >180 mg/dL (OR 1.90, 95% CI 1.68–2.16) were predictors for post-operative adverse events. Diabetes patients who underwent surgery had higher risks of infectious complications and in-hospital mortality compared with patients without diabetes who underwent similar major surgeries.
Highlights
Due to the increasing number of diabetes patients, their consumption of medical resources and economic burden has attracted attention all over the world [1,2]
Some studies have indicated that diabetes mellitus or pre-operative glucose concentration did not relate to perioperative morbidity or mortality [14,15,16]
After propensity-score matching, the reduced standardized differences were below 10% for baseline covariates such as age, sex, low-income status, types of surgery and anesthesia, hypertension, ischemic heart disease, cardiac dysrhythmias, mental disorders, heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, asthma, and renal failure or renal dialysis between surgical patients with and without diabetes (Table 2 and Figure A2)
Summary
Due to the increasing number of diabetes patients, their consumption of medical resources and economic burden has attracted attention all over the world [1,2]. Perioperative complications after cardiac and non-cardiac surgeries in patients with diabetes remain a clinical problem, even though surgical procedures have progressed [5,6]. The impact of diabetes history, elevated hemoglobin A1c (HbA1c), and higher fasting glucose on clinical outcomes after major surgeries has been evaluated in many studies, which have shown increased risks of perioperative mortality and complications including infection, stroke, and death in patients with diabetes compared to those without diabetes [7,8,9,10,11,12,13]. Limited information was available on the perioperative outcome in patients with undiagnosed diabetes, and the association between diabetes and post-operative outcomes was not fully elucidated
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