Adverse Outcomes after Major Surgeries in Patients with Diabetes: A Multicenter Matched Study

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.

RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020

“…Major inpatient surgeries are defined as procedures requiring general, epidural, or spinal anaesthesia for ≥1 h as well as hospitalization for >1 day while all other outpatient procedures may be defines as minor surgeries. [ 801 802 ]…”

“…[ 830 ] Compared to T1DM, management of glucose level is easier in T2DM, however there might be requirement of higher dose of insulin as >150 units/day i. e. approximately 50% elevation. [ 801 ] Insulin pump therapy is also considered to be beneficial in maintaining HbA1c level in pregnant women with pre-gestational diabetes, without any increase in risk of hypoglycaemia. However, cost and the risk for marked hyperglycaemia or DKA as a consequence of insulin delivery failure from could be an issue.…”

“…ADA suggests the Dietary Reference Intakes (DRI) to be >175 g of carbohydrate, >71 g of protein and about 28 g fiber in all pregnant women. [ 801 831 830 832 ]…”

Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database

“…The increased risk of infection after surgeries has been investigated in patients with diabetes. 24 37 Recent studies have demonstrated that metformin use may reduce the infectious risk in patients with diabetes. 7 8 38 Metformin has several actions that cause it to mimic an antibiotic.…”

Features of hemorrhagic fever with renal syndrome with diabetes mellitus

“…Известно, что СД является существенным фактором риска в возникновении неблагоприятных исходов и осложнений при гриппе, пневмонии, сепсисе, лекарственном поражении почек, в течение послеоперационного периода у хирургических больных, и т.д. [10][11][12][13][14][15][16][17]. Другими словаминаличие у больного с остро возникшей соматической патологией сопутствующего СД значительно ухудшает прогноз по основному заболеванию.…”