The impact of youth‐onset type 2 diabetes on postoperative wound healing complications

Abstract

Youth‐onset type 2 diabetes mellitus is associated with a more rapid decline in β cells, and earlier onset of medical complications compared to adult‐onset diabetes. However, its impact on surgical wounds remains less clear. Therefore, this study aimed to determine whether youth‐onset diabetes is a risk factor for wound healing complications in the 30‐day postoperative period. To do so, the National Surgical Quality Improvement Program Database years 2012–2019 was analysed. Patients aged 18–24 with non‐insulin‐dependent diabetes were included. Outcomes assessed included wound infections, wound dehiscence, readmissions, and reoperation. Univariate analysis identified differences between the diabetic and non‐diabetic cohorts after which, multivariate logistic regression was employed to control for potential confounding. Analysis included 1589 diabetic and 196,902 non‐diabetic patients ages 18–24. The diabetic cohort exhibited a higher proportion of female (83.8% vs. 55.2%, p < 0.001), non‐white (22.7% vs. 19.5%, p = 0.001), and Hispanic patients (16.2% vs. 13.6%, p = 0.002). Diabetic patients were less likely to have dirty or contaminated wounds (16.2% vs. 25.2%, p < 0.001); however had increased rates of superficial surgical site infections (SSSIs; 2.0% vs. 0.8%, p < 0.001) and readmission (4.0% vs. 3.0%, p = 0.026). After regression, diabetes remained a significant positive predictor of SSSI (odds ratio: 1.546, p = 0.022); however, it no longer significantly predicted 30‐day readmission. Overall, this analysis of a large multicentre surgical outcomes database found that when compared to non‐diabetics, youth‐onset diabetic patients exhibited a higher proportion of SSSIs in the 30‐day postoperative period. These infections were found, despite the diabetic cohort exhibiting lower rates of wound contamination. After controlling for confounding variables, youth‐onset diabetes remained a significant predictor of SSSI. Clinically, prevention and treatment of diabetes along with judicious wound care is recommended.

Analysing predictors of surgical site infections in patients undergoing emergency surgery for traumatic pulmonary haemorrhage

“…Whilst such surgeries are essential for saving lives, they are not without risks, and one significant complication that can arise is SSIs. SSIs pose a considerable challenge in the postoperative management of TPH patients 16,17 . It can lead to prolonged hospital stays, increased healthcare costs and in severe cases, life‐threatening systemic infections 18 .…”

“…SSIs pose a considerable challenge in the postoperative management of TPH patients. 16 , 17 It can lead to prolonged hospital stays, increased healthcare costs and in severe cases, life‐threatening systemic infections. 18 Despite advances in surgical techniques and perioperative care, the incidence of SSIs following emergency surgical treatment for TPH remains a topic of concern.…”