Adverse outcomes after noncardiac surgery in patientswith diabetes: A nationwide population-based retrospective cohort study

Chun Chieh Yeh, Chien Chang Liao, Yi Cheng Chang, Long Bin Jeng, Horng Ren Yang, Chun Chuan Shih, Ta Liang Chen

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

OBJECTIVE To investigate whether diabetes affects perioperative complications or mortality and to gauge its impact on medical expenditures for noncardiac surgeries. RESEARCH DESIGN AND METHODSdWith the use of reimbursement claims from the Taiwan National Health Insurance system, we performed a population-based cohort study of patients with and without diabetes undergoing noncardiac surgeries. Outcomes of postoperative complications, mortality, hospital stay, and medical expenditures were compared between patients with and without diabetes. RESULTSdDiabetes increased 30-day postoperative mortality (odds ratio 1.84 [95%CI 1.46- 2.32]), particularly among patients with type 1 diabetes or uncontrolled diabetes and patients with preoperative diabetes-related comorbidities, such as eye involvement, peripheral circulatory disorders, ketoacidosis, renal manifestations, and coma. Compared with nondiabetic control patients, coexisting medical conditions, such as renal dialysis (5.17 [3.68-7.28]), liver cirrhosis (3.59 [2.19-5.88]), stroke (2.87 [1.95-4.22]), mental disorders (2.35 [1.71-3.24]), ischemic heart disease (2.08 [1.45-2.99]), chronic obstructive pulmonary disease (1.96 [1.29- 2.97]), and hyperlipidemia (1.94 [1.01-3.76]) were associated with mortality for patients with diabetes undergoing noncardiac surgery. Patients with diabetes faced a higher risk of postoperative acute renal failure (3.59 [2.88-4.48]) and acute myocardial infarction (3.65 [2.43-5.49]). Furthermore, diabetes was associated with prolonged hospital stay (2.30 [2.16-2.44]) and increased medical expenditures (1.32 [1.25-1.40]). CONCLUSIONSdDiabetes increases postoperative 30-day mortality, complications, and medical expenditures in patients undergoing in-hospital noncardiac surgeries.

Original languageEnglish
Pages (from-to)3216-3221
Number of pages6
JournalDiabetes Care
Volume36
Issue number10
DOIs
Publication statusPublished - Oct 2013

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Cohort Studies
Retrospective Studies
Health Expenditures
Population
Mortality
Length of Stay
Ketosis
National Health Programs
Coma
Hyperlipidemias
Type 1 Diabetes Mellitus
Taiwan
Acute Kidney Injury
Mental Disorders
Liver Cirrhosis
Chronic Obstructive Pulmonary Disease
Myocardial Ischemia
Renal Dialysis
Comorbidity
Stroke

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Adverse outcomes after noncardiac surgery in patientswith diabetes : A nationwide population-based retrospective cohort study. / Yeh, Chun Chieh; Liao, Chien Chang; Chang, Yi Cheng; Jeng, Long Bin; Yang, Horng Ren; Shih, Chun Chuan; Chen, Ta Liang.

In: Diabetes Care, Vol. 36, No. 10, 10.2013, p. 3216-3221.

Research output: Contribution to journalArticle

Yeh, Chun Chieh ; Liao, Chien Chang ; Chang, Yi Cheng ; Jeng, Long Bin ; Yang, Horng Ren ; Shih, Chun Chuan ; Chen, Ta Liang. / Adverse outcomes after noncardiac surgery in patientswith diabetes : A nationwide population-based retrospective cohort study. In: Diabetes Care. 2013 ; Vol. 36, No. 10. pp. 3216-3221.
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abstract = "OBJECTIVE To investigate whether diabetes affects perioperative complications or mortality and to gauge its impact on medical expenditures for noncardiac surgeries. RESEARCH DESIGN AND METHODSdWith the use of reimbursement claims from the Taiwan National Health Insurance system, we performed a population-based cohort study of patients with and without diabetes undergoing noncardiac surgeries. Outcomes of postoperative complications, mortality, hospital stay, and medical expenditures were compared between patients with and without diabetes. RESULTSdDiabetes increased 30-day postoperative mortality (odds ratio 1.84 [95{\%}CI 1.46- 2.32]), particularly among patients with type 1 diabetes or uncontrolled diabetes and patients with preoperative diabetes-related comorbidities, such as eye involvement, peripheral circulatory disorders, ketoacidosis, renal manifestations, and coma. Compared with nondiabetic control patients, coexisting medical conditions, such as renal dialysis (5.17 [3.68-7.28]), liver cirrhosis (3.59 [2.19-5.88]), stroke (2.87 [1.95-4.22]), mental disorders (2.35 [1.71-3.24]), ischemic heart disease (2.08 [1.45-2.99]), chronic obstructive pulmonary disease (1.96 [1.29- 2.97]), and hyperlipidemia (1.94 [1.01-3.76]) were associated with mortality for patients with diabetes undergoing noncardiac surgery. Patients with diabetes faced a higher risk of postoperative acute renal failure (3.59 [2.88-4.48]) and acute myocardial infarction (3.65 [2.43-5.49]). Furthermore, diabetes was associated with prolonged hospital stay (2.30 [2.16-2.44]) and increased medical expenditures (1.32 [1.25-1.40]). CONCLUSIONSdDiabetes increases postoperative 30-day mortality, complications, and medical expenditures in patients undergoing in-hospital noncardiac surgeries.",
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AB - OBJECTIVE To investigate whether diabetes affects perioperative complications or mortality and to gauge its impact on medical expenditures for noncardiac surgeries. RESEARCH DESIGN AND METHODSdWith the use of reimbursement claims from the Taiwan National Health Insurance system, we performed a population-based cohort study of patients with and without diabetes undergoing noncardiac surgeries. Outcomes of postoperative complications, mortality, hospital stay, and medical expenditures were compared between patients with and without diabetes. RESULTSdDiabetes increased 30-day postoperative mortality (odds ratio 1.84 [95%CI 1.46- 2.32]), particularly among patients with type 1 diabetes or uncontrolled diabetes and patients with preoperative diabetes-related comorbidities, such as eye involvement, peripheral circulatory disorders, ketoacidosis, renal manifestations, and coma. Compared with nondiabetic control patients, coexisting medical conditions, such as renal dialysis (5.17 [3.68-7.28]), liver cirrhosis (3.59 [2.19-5.88]), stroke (2.87 [1.95-4.22]), mental disorders (2.35 [1.71-3.24]), ischemic heart disease (2.08 [1.45-2.99]), chronic obstructive pulmonary disease (1.96 [1.29- 2.97]), and hyperlipidemia (1.94 [1.01-3.76]) were associated with mortality for patients with diabetes undergoing noncardiac surgery. Patients with diabetes faced a higher risk of postoperative acute renal failure (3.59 [2.88-4.48]) and acute myocardial infarction (3.65 [2.43-5.49]). Furthermore, diabetes was associated with prolonged hospital stay (2.30 [2.16-2.44]) and increased medical expenditures (1.32 [1.25-1.40]). CONCLUSIONSdDiabetes increases postoperative 30-day mortality, complications, and medical expenditures in patients undergoing in-hospital noncardiac surgeries.

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