Impact of steroid use and glucose control on surgical outcomes in diabetic gynecologic oncology patients

Abstract

<h3>Objectives:</h3> The objective of this study was to assess the impact of preoperative steroid use and glucose control on postoperative outcomes for diabetes mellitus (DM) gynecologic oncology patients undergoing surgery. <h3>Methods:</h3> This retrospective cohort study included all gynecologic oncology patients admitted for inpatient surgery on an enhanced recovery protocol (ERP) between 10/2016 and 12/2018 with the addition of further patients with DM until 9/2019. The utilization of preoperative steroids has largely been adopted in most ERP patients. At our institution, 8mg intravenous dexamethasone is frequently used. Individual chart review was completed to identify the primary outcome of postoperative complications including: DKA, surgical site infection, ileus, DVT/PE, CVA, MI, AKI, unplanned ICU admission, pulmonary complications, and blood transfusions. Secondary outcomes included length of hospital stay (LOS) and readmission rate. SPSS v. 25 was used for statistical analysis. <h3>Results:</h3> 684 patients were identified and 184 (26.9%) had coexisting type I or II DM. Demographics including CCI, race, diagnosis, and surgical complexity were similar between groups. Patients with DM tended to be older, have a larger body mass index (BMI), and longer operative times. The overall complication rate was 32.5%. Patients with DM were more likely to have postoperative complications (77.5% vs. 15.9%, P=0.0001), increased LOS (4.0±4.6 vs. 3.1±1.9 days, P=0.001), though no difference in readmission rate was observed (10.3% vs. 7.6%, P=0.25). Patients were more likely to have postoperative complications if they had at least one documented serum glucose greater than 300 (74.1% vs 26.8%, P=0.0001) or an average serum glucose greater than 180mg/dL in the first 24 hours (80.0% vs 24.8%, P=0.0001). 54.3% of DM patients got preoperative steroids with no difference in complication or readmission rates seen (p=0.1; p=0.7). <h3>Conclusions:</h3> Diabetic patients are at a much higher risk for postoperative complications after gynecologic oncology surgery. There was no increased risk for postoperative complications in DM patients who received steroids as part of the ERP. However, poorly controlled glucose levels in the immediate postoperative period were associated with a higher rate of complications. Adequate blood glucose control perioperatively for these high-risk patients undergoing surgery is vital given the increased risk of postoperative complications and length of stay.