Impact of Diabetes Mellitus Following Tonsillectomy in Adults: A National Surgical Quality Improvement Program Analysis

Abstract

Objectives: To identify 30-day complication rates specific to patients with diabetes mellitus following tonsillectomy. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing tonsillectomy between 2005 and 2018. Patients were stratified into 3 cohorts: insulin-dependent diabetes mellitus (IDDM), non-insulin-dependent diabetes mellitus (NIDDM), and non-diabetes mellitus (NODM). Coarsened-exact-matching was utilized to account for baseline differences between cohorts. Outcomes studied included post-operate complications, prolonged hospitalization, and unplanned readmissions. Results: A total of 986 DM and 26 774 NODM patients were included, and the mean age of patients undergoing tonsillectomy was 29.5 ± 11.6 and 28.7 ± 11.0 years, respectively. The majority of patients were female (70.5% for both DM and NODM cohorts) and White/Caucasian (89.2% vs 89.3%). Among patients undergoing tonsillectomy, a greater proportion of DM patients experienced an operative time greater than or equal to the 75th percentile (35 minutes; 25.9% vs 22.8%, P = .024), overall morbidity (12.6% vs 5.4%, P < .001), pneumonia (0.6% vs 0.2%, P = .036), and reoperation (10.2% vs 3.5% P < .001) in comparison to NODM patients. In an analysis between IDDM (n = 379) and NIDDM (n = 211) patients, IDDM patients were at an increased risk for prolonged hospitalization (1.4% vs 0.0%, P = .045), pneumonia (5.2% vs 0.5%, P < .001), urinary tract infections (3.3% vs 0.3% P = .004), major complications (15.6% vs 7.7%, P = .002), minor complications (19.9% vs 8.2%, P < .001), and overall complications (10.0% vs 1.3%, P < .001). Conclusion: DM patients are at a heightened risk for complications following tonsillectomy. Standardized protocols, careful pre-operative planning, and stringent glycemic management may help optimize patient outcomes.

Postoperative short-term mortality between insulin-treated and non-insulin-treated patients with diabetes after non-cardiac surgery: a systematic review and meta-analysis

“…Twenty-two studies were included, involving 208,214 patients with diabetes, of which 70,806 were insulin-treated and 137,408 were non-insulin-treated. The average age of participants in 15 studies was over 60 years ( 15 , 19 , 22 , 33 – 35 , 38 – 41 , 43 – 46 , 49 ), while the average age of participants in four studies was <60 years ( 37 , 42 , 47 , 48 ). We were unable to determine the average age in three studies ( 16 , 23 , 36 ).…”

“…Most of them scored five points. Only two studies were rated as high quality ( 38 , 47 ). The details of the NOS scores are shown in Table 2 .…”

“…The details of the NOS scores are shown in Table 2 . Regarding the comparability score, only three studies controlled for the most important confounding factor ( 36 , 38 , 47 ), and only three studies controlled for the second most important confounding factor ( 23 , 38 , 47 ).…”

“…Although all the included studies provided postoperative death outcomes for insulin-treated diabetes and non-insulin-treated diabetes, only seven studies specifically compared postoperative mortality outcomes between insulin-treated and non-insulin-treated diabetes ( 19 , 22 , 23 , 33 , 36 , 38 , 47 ). Only one study found that insulin-treated diabetes was associated with increased postoperative mortality compared to non-insulin-treated diabetes ( 19 ).…”