Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical aortic valve replacement in Spain (2001–2015)

López‐de‐Andrés, Ana; Miguel-Díez, Javier de; Muñoz‐Rivas, Nuria; Hernández-Barrera, Valentín; Méndez‐Bailón, Manuel; Miguel‐Yanes, José M. de; Jiménez‐García, Rodrigo

doi:10.1186/s12933-018-0780-2

Cited by 25 publications

(22 citation statements)

References 44 publications

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“…First, according to several studies, Spanish T2DM patients are undergoing more complex surgeries, all of which have a high risk of postsurgical complications (coronary artery bypass graft, surgical aortic valve replacement, solid organ transplants, bariatric surgery, revision of total hip and knee arthroplasty) more frequently over time. Furthermore, the rates of these surgeries are increasing over time among T2DM patients and are higher than those among nondiabetic patients [24–28]. Second, as described in this and previous investigations, the mean age and the prevalence of concomitant conditions among T2DM patients have increased in recent decades [24–29].…”

Section: Discussionmentioning

confidence: 68%

“…Furthermore, the rates of these surgeries are increasing over time among T2DM patients and are higher than those among nondiabetic patients [24–28]. Second, as described in this and previous investigations, the mean age and the prevalence of concomitant conditions among T2DM patients have increased in recent decades [24–29]. Third, as suggested by Trinh et al, pneumonia is becoming better recognized in postoperative patients, resulting in an increase in the incidence [30].…”

Section: Discussionmentioning

confidence: 99%

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Type 2 diabetes and postoperative pneumonia: An observational, population-based study using the Spanish Hospital Discharge Database, 2001-2015

et al. 2019

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PurposeWe analyzed temporal trends, demographic and clinical characteristics and hospital mortality rates of postoperative pneumonia among type 2 diabetes mellitus (T2DM) patients in Spain from 2001 to 2015. We also compared the incidence, comorbidities and mortality between patients with and without T2DM suffering from postoperative pneumonia. Finally, we analyzed the factors involved in the prediction of in-hospital mortality among patients suffering postoperative pneumonia.MethodsWe used the Spanish National Hospital Discharge Database for the period 2001–2015. We analyzed patients aged 40 years or over who had been hospitalized for a surgical procedure and suffered pneumonia or ventilator-associated pneumonia during their hospital admission. We compared patients with and without T2DM. The main outcome measures were the type of surgical procedure, the presence of a comorbidity, the type of isolated pathogens, admission to the emergency room (ER) and in-hospital mortality (IHM).ResultsWe selected 117,665 hospitalized patients who suffered postoperative pneumonia (16.9% with T2DM). After multivariable adjustment, T2DM patients had a 21% higher incidence of postoperative pneumonia than nondiabetic patients (IRR 1.21, 95% CI 1.03–1.42). The IHM was approximately 31% in both groups. Predictors of IHM included age, the presence of comorbidities, treatment with a pleural drainage tube, dialysis, blood transfusion, mechanical ventilation and admission to the ER. From 2001 to 2015, the IHM decreased significantly in both populations. Suffering from T2DM was not a predictor of IHM (OR 0.99, 95% CI 0.96–1.03) in our investigation.ConclusionsT2DM patients have a higher incidence of postoperative pneumonia than those without this disease. The IHM decreased from 2001 to 2015, regardless of T2DM status. T2DM did not predict a higher IHM after suffering from postoperative pneumonia.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Type 2 diabetes and postoperative pneumonia: An observational, population-based study using the Spanish Hospital Discharge Database, 2001-2015

et al. 2019

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“…Despite these limitations, the quality and validity of our dataset has been assessed and has been found to be useful for health research [10]. Furthermore, this dataset reflects the outcome of a real-world population, which is different from that selected in randomized controlled trials.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence rates of admission for SMVR among T2DM patients and non-T2DM patients per 100,000 inhabitants were estimated using the methods described in previous studies [10]. Poisson regression models adjusted by age and sex were used to assess the time trends for study groups providing incidence rate ratios (IRR) with 95% confidence interval as the measure of association.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies have found that those suffering from diabetes have a higher long-term mortality after SMVR than those not suffering from diabetes [9]. For other valve procedures, such as surgical aortic valve replacement, suffering from type 2 diabetes (T2MD) has been associated with significantly lower in-hospital mortality (IHM) than among those not suffering from type 2 diabetes [10].…”

Section: Introductionmentioning

confidence: 99%

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Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical mitral valve replacement in Spain (2001–2015)

López‐de‐Andrés

Miguel-Díez

Muñoz‐Rivas

et al. 2019

Cardiovasc Diabetol

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Background The main aims of this study were to examine the incidence and in-hospital outcomes of mechanical and bioprosthetic surgical mitral valve replacement (SMVR) among patients with and without T2DM. Methods We performed a retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. We included patients with SMVR codified in their discharge report. We grouped admissions by diabetes status. Propensity score matching (PSM) was used to compare outcomes of isolated SMVR. Results We identified 42,937 patients (16.41% with T2DM). Incidence rates of mechanical and bioprosthetic SMVR were higher among T2DM patients than among non-T2DM patients. In both groups of patients, the use of bioprosthetic SMVR increased over time. The use of mechanical valves remained stable among T2DM patients. In T2DM and non-T2DM patients with mechanical SMVR, in hospital mortality (IHM) and MACCE decreased significantly (p < 0.001) from 2001 to 2015. T2DM patients had an overall 11.37% IHM, compared with 10.76% among non-T2DM patients (p = 0.176). Regarding MACCE figures were 14.72% vs. 14.22% (p = 0.320) after mechanical SMVR. Total crude IHM were 14.29% for T2DM patients and 15.13% for those without T2DM with bioprosthetic SMVR (p = 0.165) and 18.22 vs. 19.64%, for a MACCE (p = 0.185). Using PSM we found that the IHM and the MACCE of isolated SMVR did not differ significantly between patients with or without T2DM beside the type of valve replacement. Among T2DM patients, those who received bioprosthetic valves had higher IHM (14.29% vs. 11.37%; p = 0.003) and a higher rate of MACCE (18.22% vs. 14.72%; p = 0.001) than T2DM patients with mechanical SMVR. Conclusions In Spain from 2001 to 2015, the incidence rates of hospitalization to undergo mechanical or bioprosthetic SMVR were higher among the population suffering T2DM than among the non-T2DM population. In both groups of patients the use of bioprosthetic SMVR increased over time and the use of mechanical valves remained stable in T2DM. T2DM patients have IHM and MACCE after mechanical and bioprosthetic SMVR which are not significantly different to those found among non-diabetic patients. Among T2DM patients, the crude IHM was significantly higher in those who received a bioprosthetic SMVR than those with mechanical SMVR. Electronic supplementary material The online version of this article (10.1186/s12933-019-0866-5) contains supplementary material, which is available to authorized users.

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Impact of Procedure Volume on the Outcomes of Surgical Aortic Valve Replacement

Oettinger

Kaier

Mühlen

et al. 2022

Thorac Cardiovasc Surg

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Background Literature demonstrated that procedure volumes affect outcomes of patients undergoing transcatheter aortic valve implantation. We evaluated the outcomes of surgical aortic valve replacement. Methods All isolated surgical aortic valve replacement procedures in Germany in 2017 were identified. Hospitals were divided into five groups from ≤25 (very low volume) until >100 (very high volume) annual procedures. Results In 2017, 5,533 patients underwent isolated surgical aortic valve replacement. All groups were of comparable risk (logistic EuroSCORE, 5.12–4.80%) and age (66.6–68.1 years). In-hospital mortality and complication rates were lowest in the very high-volume group. Multivariable logistic regression analyses showed no significant volume–outcome relationship for in-hospital mortality, stroke, postoperative delirium, and mechanical ventilation > 48 hours. Regarding acute kidney injury, patients in the very high-volume group were at lower risk than those in the very low volume group (odds ratio [OR] = 0.53, p = 0.04). Risk factors for in-hospital mortality were previous cardiac surgery (OR = 5.75, p < 0.001), high-grade renal disease (glomerular filtration rate < 15 mL/min, OR = 5.61, p = 0.002), surgery in emergency cases (OR = 2.71, p = 0.002), and higher grade heart failure (NYHA [New York Heart Association] III/IV; OR = 1.80, p = 0.02). Risk factors for all four complication rates were atrial fibrillation and diabetes mellitus. Conclusion Patients treated in very low volume centers (≤25 operations/year) had a similar risk regarding in-hospital mortality and most complications compared with very high-volume centers (>100 operations/year). Only in the case of acute kidney injury, very high-volume centers showed better outcomes than very low volume centers. Therefore, surgical aortic valve replacement can be performed safely independent of case volume.

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Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical aortic valve replacement in Spain (2001–2015)

Cited by 25 publications

References 44 publications

Type 2 diabetes and postoperative pneumonia: An observational, population-based study using the Spanish Hospital Discharge Database, 2001-2015

Type 2 diabetes and postoperative pneumonia: An observational, population-based study using the Spanish Hospital Discharge Database, 2001-2015

Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical mitral valve replacement in Spain (2001–2015)

Impact of Procedure Volume on the Outcomes of Surgical Aortic Valve Replacement

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