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Diabetes raises risks for adverse outcomes following any surgery
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Compared with adults without diabetes, those with the disease are more likely to experience adverse outcomes following any surgery — including mortality, complications, ICU admission and mechanical ventilation — with greater risks associated with increasing HbA1c levels, according to a study published in Diabetes Care.
“While we ... already knew that people with diabetes had poorer outcomes following cardiac surgery, this is the first comprehensive study worldwide showing that these patients have poorer outcomes across all surgeries,” Elif Ekinci, FRACP, PhD, associate professor and Sir Edward Dunlop Medical Research Foundation principal research fellow in metabolic medicine at the University of Melbourne in Australia, said in a press release. “A significant finding of the current study is that poor blood sugar control before surgery, as reflected by higher HbA1c levels, is an important risk factor for major complications and intensive care unit admission.”
Ekinci and colleagues conducted a prospective, observational study of 7,565 surgical inpatients aged at least 54 years who had been admitted to Austin Health in Melbourne, Australia, between May 2013 and January 2016. Researchers divided patients into three groups: those with diabetes (including a previous diagnosis or HbA1c 6.5%; n = 2,283; 62% men; mean age, 71 years; median HbA1c, 6.9%), those with prediabetes (HbA1c 5.7%-6.4%; n = 2,825; 54% men; mean age, 71 years; median HbA1c, 5.9%) and those with normoglycemia (HbA1c < 5.7%; n = 1,395; 57% men; mean age, 68 years; median HbA1c, 5.4). Patients with prediabetes and normoglycemia were subsequently grouped together as not having diabetes. Hospital records were used to obtain baseline demographic and clinical data. Patients were followed for 6 months.
Researchers considered all patients’ length of stay (time of admission to discharge), hospital-acquired complications (graded using the Clavien-Dindo classification guide for surgical complications), comorbidities (calculated using the Charlson comorbidity index), length of surgery in minutes, whether the surgery was an emergency or a nonemergency, and surgical unit of discharge.
Researchers then used random-effects logistic and negative binomial regression models, with each surgical unit treated as a random effect. In addition, classification and regression tree analysis was used to create a 6-month mortality risk model.
After adjusting for age, Charlson comorbidity index, estimated glomerular filtration rate and length of surgery, researchers found that diabetes was associated with increased 6-month mortality (adjusted OR = 1.29; 95% CI, 1.05-1.58), with an incidence of 6% (95% CI, 5.5-6.8) in patients without diabetes and 9% (95% CI, 7.4-9.7) in patients with diabetes. Furthermore, 14% (95% CI, 13-15) of patients without diabetes had a major complication vs. 21% (95% CI, 20-23) of patients with diabetes. Using multivariable analysis, researchers found that diabetes as a categorical variable was associated with a higher risk for major complications (aOR = 1.32; 95% CI, 1.14-1.52), and each 1% increase in HbA1c was associated with a greater risk for major complications when assessed as a continuous variable (aOR = 1.07; 95% CI, 1.01-1.14). Diabetes was associated with increased ICU admission (18% of patients without diabetes vs. 27% with diabetes) and use of mechanical ventilation (10% vs. 16%). In addition, each percentage increase in HbA1c was associated with a greater likelihood of ICU admission (aOR = 1.14; 95% CI, 1.07-1.21) and increased length of stay (adjusted incidence rate ratio = 1.05; 95% CI, 1.03-1.06).
“Diabetes currently impacts 8.8% of the world’s population, and its prevalence is rising,” Ekinci said in the release. “Therefore, it is imperative that we understand the risk of outcomes following surgery on people with diabetes.” – by Melissa J. Webb
For more information:
Elif Ekinci, FRACP, PhD, can be reached at elif.ekinci@unimelb.edu.au.
Disclosures: The authors report no relevant financial disclosures.
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