P-065 Impact of Diabetes on Short-Term Postoperative Morbidities in Patients Undergoing Ileal Pouch Surgery

Abstract

Although medical management of diabetes has improved, there are data suggesting increased risk of adverse outcomes for abdominal surgeries in diabetics. Previously identified risk factors for short-term postoperative morbidities in ileal pouch surgery include preoperative hypoalbuminemia and steroid use. The aim of this study is to determine whether diabetes is an independent risk factor for adverse perioperative outcomes of ileal pouch surgery. The America College of Surgeon's National Surgical Quality Improvement (NSQIP) program database (2005 to 2011) was queried to identify patients undergoing ileal pouch-anal anastomosis (IPAA). Patient characteristics, comorbidities, steroid use, and 30-day morbidities were compared between diabetics and nondiabetics. Serious complications were defined as organ failure, stroke, mortality, return for further surgery, and transfusion. Univariate and multivariable analyses were performed to evaluate the impact of diabetes on 30-day postoperative outcomes. During the period of study, 2,957 patients were identified in the NSQIP database as having undergone IPAA. Of these patients, 175 (5.9%) were diabetic. Steroid use and anemia were not significantly different between the groups, but preoperative albumin was lower (3.89 versus 3.6, P = 0.0013), BMI was higher in diabetics and comorbidities including CHF, renal impairment, COPD were increased among diabetics. The unadjusted incidence of mortality was higher in diabetics with 6/175 (3.4%) in diabetics versus 12/2,789 deaths (0.4%) in nondiabetics (P = 0.0004). Septic shock, wound infection, cardiac arrest, and organ failure were significantly increased in diabetics with univariate analysis. Length of stay was longer for diabetics (8.25 versus 10.11 days, P = 0.0013). Multivariate analysis did not reveal diabetes as an independent risk factor for serious complications (OR 1.35, CI 0.9–2.03). Preoperative sepsis was identified as a risk factor for complications (OR 2.89, 1.69–4.96). Conclusion: Analysis of data from a national database reveals that diabetics undergoing IPAA have an unadjusted increased risk of 30 day mortality. However diabetes is was not an independent risk factor for serious short term complications of surgery in these analyses. Identification of risk factors in diabetics may improve outcomes and risk stratification.