Adverse Outcomes after Major Surgeries in Patients with Diabetes

A Multicenter Matched Study

Research output: Contribution to journalArticle

Abstract

The impact of diabetes on perioperative outcomes remains incompletely understood. Our purpose is to evaluate post-operative complications and mortality in patients with diabetes. Using the institutional and clinical databases of three university hospitals from 2009⁻2015, we conducted a matched study of 16,539 diabetes patients, aged >20 years, who underwent major surgery. Using a propensity score matching procedure, 16,539 surgical patients without diabetes who underwent surgery were also selected. Logistic regressions were used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for post-operative complications and in-hospital mortality associated with diabetes. Patients with diabetes had a higher risk of postoperative septicemia (OR 1.33, 95% CI 1.01⁻1.74), necrotizing fasciitis (OR 3.98, 95% CI 1.12⁻14.2), cellulitis (OR 2.10, 95% CI 1.46⁻3.03), acute pyelonephritis (OR 1.86, 95% CI 1.01⁻3.41), infectious arthritis (OR 3.89, 95% CI 1.19⁻12.7), and in-hospital mortality (OR 1.51, 95% CI 1.07⁻2.13) compared to people without diabetes. Previous admission for diabetes (OR 2.33, 95% CI 1.85⁻2.93), HbA1c >8% (OR 1.96, 95% CI 1.64⁻2.33) and fasting glucose >180 mg/dL (OR 1.90, 95% CI 1.68⁻2.16) were predictors for post-operative adverse events. Diabetes patients who underwent surgery had higher risks of infectious complications and in-hospital mortality compared with patients without diabetes who underwent similar major surgeries.

Original languageEnglish
JournalJournal of Clinical Medicine
Volume8
Issue number1
DOIs
Publication statusPublished - Jan 16 2019

Fingerprint

Multicenter Studies
Odds Ratio
Confidence Intervals
Hospital Mortality
Necrotizing Fasciitis
Propensity Score
Infectious Arthritis
Cellulitis
Pyelonephritis
Fasting
Sepsis
Logistic Models
Databases
Glucose
Mortality

Cite this

@article{dfcdb197734e4156a77caa1af775ec2c,
title = "Adverse Outcomes after Major Surgeries in Patients with Diabetes: A Multicenter Matched Study",
abstract = "The impact of diabetes on perioperative outcomes remains incompletely understood. Our purpose is to evaluate post-operative complications and mortality in patients with diabetes. Using the institutional and clinical databases of three university hospitals from 2009⁻2015, we conducted a matched study of 16,539 diabetes patients, aged >20 years, who underwent major surgery. Using a propensity score matching procedure, 16,539 surgical patients without diabetes who underwent surgery were also selected. Logistic regressions were used to calculate the odds ratios (ORs) with 95{\%} confidence intervals (CIs) for post-operative complications and in-hospital mortality associated with diabetes. Patients with diabetes had a higher risk of postoperative septicemia (OR 1.33, 95{\%} CI 1.01⁻1.74), necrotizing fasciitis (OR 3.98, 95{\%} CI 1.12⁻14.2), cellulitis (OR 2.10, 95{\%} CI 1.46⁻3.03), acute pyelonephritis (OR 1.86, 95{\%} CI 1.01⁻3.41), infectious arthritis (OR 3.89, 95{\%} CI 1.19⁻12.7), and in-hospital mortality (OR 1.51, 95{\%} CI 1.07⁻2.13) compared to people without diabetes. Previous admission for diabetes (OR 2.33, 95{\%} CI 1.85⁻2.93), HbA1c >8{\%} (OR 1.96, 95{\%} CI 1.64⁻2.33) and fasting glucose >180 mg/dL (OR 1.90, 95{\%} CI 1.68⁻2.16) were predictors for post-operative adverse events. Diabetes patients who underwent surgery had higher risks of infectious complications and in-hospital mortality compared with patients without diabetes who underwent similar major surgeries.",
author = "Chao-Shun Lin and Chuen-Chau Chang and Yuan-Wen Lee and Chih-Chung Liu and Chun-Chieh Yeh and Yi-Cheng Chang and Ming-Tsang Chuang and Tzu-Hao Chang and Ta-Liang Chen and Chien-Chang Liao",
year = "2019",
month = "1",
day = "16",
doi = "10.3390/jcm8010100",
language = "English",
volume = "8",
journal = "Journal of Clinical Medicine",
issn = "2077-0383",
publisher = "MDPI AG",
number = "1",

}

TY - JOUR

T1 - Adverse Outcomes after Major Surgeries in Patients with Diabetes

T2 - A Multicenter Matched Study

AU - Lin, Chao-Shun

AU - Chang, Chuen-Chau

AU - Lee, Yuan-Wen

AU - Liu, Chih-Chung

AU - Yeh, Chun-Chieh

AU - Chang, Yi-Cheng

AU - Chuang, Ming-Tsang

AU - Chang, Tzu-Hao

AU - Chen, Ta-Liang

AU - Liao, Chien-Chang

PY - 2019/1/16

Y1 - 2019/1/16

N2 - The impact of diabetes on perioperative outcomes remains incompletely understood. Our purpose is to evaluate post-operative complications and mortality in patients with diabetes. Using the institutional and clinical databases of three university hospitals from 2009⁻2015, we conducted a matched study of 16,539 diabetes patients, aged >20 years, who underwent major surgery. Using a propensity score matching procedure, 16,539 surgical patients without diabetes who underwent surgery were also selected. Logistic regressions were used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for post-operative complications and in-hospital mortality associated with diabetes. Patients with diabetes had a higher risk of postoperative septicemia (OR 1.33, 95% CI 1.01⁻1.74), necrotizing fasciitis (OR 3.98, 95% CI 1.12⁻14.2), cellulitis (OR 2.10, 95% CI 1.46⁻3.03), acute pyelonephritis (OR 1.86, 95% CI 1.01⁻3.41), infectious arthritis (OR 3.89, 95% CI 1.19⁻12.7), and in-hospital mortality (OR 1.51, 95% CI 1.07⁻2.13) compared to people without diabetes. Previous admission for diabetes (OR 2.33, 95% CI 1.85⁻2.93), HbA1c >8% (OR 1.96, 95% CI 1.64⁻2.33) and fasting glucose >180 mg/dL (OR 1.90, 95% CI 1.68⁻2.16) were predictors for post-operative adverse events. Diabetes patients who underwent surgery had higher risks of infectious complications and in-hospital mortality compared with patients without diabetes who underwent similar major surgeries.

AB - The impact of diabetes on perioperative outcomes remains incompletely understood. Our purpose is to evaluate post-operative complications and mortality in patients with diabetes. Using the institutional and clinical databases of three university hospitals from 2009⁻2015, we conducted a matched study of 16,539 diabetes patients, aged >20 years, who underwent major surgery. Using a propensity score matching procedure, 16,539 surgical patients without diabetes who underwent surgery were also selected. Logistic regressions were used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for post-operative complications and in-hospital mortality associated with diabetes. Patients with diabetes had a higher risk of postoperative septicemia (OR 1.33, 95% CI 1.01⁻1.74), necrotizing fasciitis (OR 3.98, 95% CI 1.12⁻14.2), cellulitis (OR 2.10, 95% CI 1.46⁻3.03), acute pyelonephritis (OR 1.86, 95% CI 1.01⁻3.41), infectious arthritis (OR 3.89, 95% CI 1.19⁻12.7), and in-hospital mortality (OR 1.51, 95% CI 1.07⁻2.13) compared to people without diabetes. Previous admission for diabetes (OR 2.33, 95% CI 1.85⁻2.93), HbA1c >8% (OR 1.96, 95% CI 1.64⁻2.33) and fasting glucose >180 mg/dL (OR 1.90, 95% CI 1.68⁻2.16) were predictors for post-operative adverse events. Diabetes patients who underwent surgery had higher risks of infectious complications and in-hospital mortality compared with patients without diabetes who underwent similar major surgeries.

U2 - 10.3390/jcm8010100

DO - 10.3390/jcm8010100

M3 - Article

VL - 8

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

SN - 2077-0383

IS - 1

ER -