Adverse Outcomes After Noncardiac Surgery in Patients With Diabetes

Abstract

OBJECTIVETo investigate whether diabetes affects perioperative complications or mortality and to gauge its impact on medical expenditures for noncardiac surgeries.RESEARCH DESIGN AND METHODSWith the use of reimbursement claims from the Taiwan National Health Insurance system, we performed a population-based cohort study of patients with and without diabetes undergoing noncardiac surgeries. Outcomes of postoperative complications, mortality, hospital stay, and medical expenditures were compared between patients with and without diabetes.RESULTSDiabetes increased 30-day postoperative mortality (odds ratio 1.84 [95% CI 1.46–2.32]), particularly among patients with type 1 diabetes or uncontrolled diabetes and patients with preoperative diabetes-related comorbidities, such as eye involvement, peripheral circulatory disorders, ketoacidosis, renal manifestations, and coma. Compared with nondiabetic control patients, coexisting medical conditions, such as renal dialysis (5.17 [3.68–7.28]), liver cirrhosis (3.59 [2.19–5.88]), stroke (2.87 [1.95–4.22]), mental disorders (2.35 [1.71–3.24]), ischemic heart disease (2.08 [1.45–2.99]), chronic obstructive pulmonary disease (1.96 [1.29–2.97]), and hyperlipidemia (1.94 [1.01–3.76]) were associated with mortality for patients with diabetes undergoing noncardiac surgery. Patients with diabetes faced a higher risk of postoperative acute renal failure (3.59 [2.88–4.48]) and acute myocardial infarction (3.65 [2.43–5.49]). Furthermore, diabetes was associated with prolonged hospital stay (2.30 [2.16–2.44]) and increased medical expenditures (1.32 [1.25–1.40]).CONCLUSIONSDiabetes increases postoperative 30-day mortality, complications, and medical expenditures in patients undergoing in-hospital noncardiac surgeries.

Adverse outcomes after major surgery in patients with pressure ulcer: A nationwide population-based retrospective cohort study

“…Second, because this study lacks detailed grading of preoperative pressure ulcer [26], we could not investigate the impact of severity of pressure ulcer on postoperative mortality. In addition, as our study used ICD-9-CM codes to define coexisting medical conditions and postoperative complications, miscoding due to human error could not be avoided; however, the accuracy of the National Health Insurance Research Database has been accepted in numerous scientific publications [13][14][15][16]24]. Finally, possibly inadequate adjustment of confounding factors in use of propensity score-matched pair technique might cause neglected bias in the study.…”

“…Although the association between preoperative pressure ulcer and postoperative adverse outcomes was still unclear, previous studies had identified factors associated with postoperative pressure ulcer such as old age, types of surgeries and coexisting medical conditions [17,18]. These factors were also associated with major adverse events after surgery [14][15][16][19][20][21][22][23][24][25]. To reduce the confounding errors, we adjusted these covariates using propensity score-matched procedure and then controlled these factors in the multivariate Poisson regression models.…”

“…The National Health Research Institutes established the National Health Insurance Research Database that records all beneficiaries' medical services, including inpatient and outpatient demographics, primary and secondary diagnoses, procedures, prescriptions and medical expenditures for public research interest. The validity of this database has been favorably evaluated, and research articles based on it have been accepted in prominent scientific journals worldwide [13][14][15][16].…”

“…However, this study was evaluated and approved by Taiwan's National Health Research Institutes (NHIRD-103-121). The data are owned by the National Health Insurance Research Database Committee [13][14][15][16] and the contact information is available as email: nhird@nhri.org.tw.…”

“…In-hospital 30-day mortality after the index surgery was considered the study's primary outcome. Eight major surgical postoperative complications were noted, including septicemia (ICD-9-CM 038, 998.5), pneumonia (ICD-9-CM 480-486), stroke (ICD-9-CM 430-438), urinary tract infection (ICD-9-CM 599.0), acute renal failure (ICD-9-CM 584), deep wound infection (ICD-9-CM 958.3), pulmonary embolism (ICD-9-CM 415), postoperative bleeding (ICD-9-CM 998.0, 998.1 and 998.2) and acute myocardial infarction (ICD-9-CM 410) after the index surgery [15,16]. Admission to intensive care unit, prolonged length of stay, and increased medical expenditure after index surgery were analyzed as secondary outcomes.…”