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27-03-2012 | Surgery | Article

Diabetes impact on colectomy outcomes revealed


Free abstract

MedWire News: Diabetes significantly increases the risk for poor postoperative outcomes following colectomy, especially in patients using steroids, study findings suggest.

The research, published in the Archives of Surgery, found that although diabetes did not increase the risk for anastomotic leak, it significantly increased the risk for death from this complication.

"This finding could play an important role in the operative decision making process to limit these risks (ie, by performing fecal diversion)," write Matthew A Ziegler (Indiana University, Indianapolis, USA) and co-workers.

"Our study also merits further research to determine whether optimal blood glucose control will improve surgical outcomes, mortality, and rates of rescue following postoperative complications."

The team investigated the impact of diabetes on postcolectomy mortality and anastomotic leak in 5123 patients, including 889 individuals with a diagnosis of diabetes, who underwent open or laparoscopic right or left hemicolectomies between 2008 and 2010 at a Michigan Surgical Quality Collaborative hospital. Around 10% of procedures were performed as emergency surgery.

Preoperative glucose measurements showed that 15.6% of patients experienced hyperglycemia, defined as having a glucose level of 140 mg/dL or above, and just half (54%) of these patients had a history of diabetes.

Overall, 3.0% of patients developed leaks, and 3.0% of patients died within 30 days of surgery. The rate of anastomotic leak did not significantly differ between patients with and without diabetes (2.1 vs 3.2%).

In multivariate analysis, anastomotic leak was significantly associated with preoperative steroid use in patients with diabetes compared with nondiabetes patients (8.8 vs 1.9%, odds ratio [OR]=4.6).

The risk for anastomosis was not influenced by hyperglycemia, emergency surgery, American Society of Anesthesiologists score, gender, and open versus laparoscopic procedure, Ziegler et al say.

Patients with diabetes were significantly more likely to die than those without diabetes (5.1 vs 2.6%). Patients with anastomic leak were significantly more likely to die than those without; this was true for both diabetes patients (26.3 vs 4.5%) and those without diabetes (6.0 vs 2.5%).

Further analysis revealed an increased risk for mortality from hyperglycemia that occurred only for nondiabetes patients (8.5 vs 2.2%), but no significant difference in mortality was found for diabetes patients with and without hyperglycemia (5.9 vs 4.5%).

Noticing that the highest rates for mortality was among diabetes patients and hyperglycemic patients not yet diagnosed with diabetes, the researchers comment: "It seems likely that the detrimental effects of diabetes mellitus on the microvasculature, combined with the negative effect of steroids on healing, contribute to the higher observed anastomotic leak rates in this population.

"Furthermore, the associated components of the metabolic syndrome that are often seen in diabetic patients (ie, hypertension, obesity, dyslipidemia, and vascular disease) likely confer a significantly greater risk of postoperative mortality, especially in the event of a leak."

By Lynda Williams

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