Impact of Diabetes on Postoperative Outcomes Following Colon Cancer Surgery

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2010 Mar 31

PMID 20352362

Citations 13

Authors

Nitasha Anand

Christopher A Chong

Rachel Y Chong

Geoffrey C Nguyen

Affiliations

Soon will be listed here.

Abstract

Background: Diabetes is the sixth most common cause of death in the US and causes significant postoperative mortality and morbidity.

Objective: To characterize the impact of diabetes among patients undergoing surgery for colorectal cancer.

Design: This is is a retrospective cohort study.

Participants: Patients in the Nationwide Inpatient Sample (NIS) who had undergone colorectal cancer surgery between 1998 and 2005.

Measurements: Using multivariate regression, we determined the association of diabetes status with postoperative mortality, postoperative complications, and length of stay.

Key Results: An estimated 218,534 patients had undergone surgery for colorectal cancer. We categorized subjects by the presence of diabetes, the prevalence of which was 15%. Crude postoperative in-hospital mortality was lower among diabetics compared to non-diabetics (2.5% vs. 3.2%, P < 0.0001). Adjusted mortality was 23% lower in those with diabetes compared to non-diabetics (aOR 0.77; 95% CI: 0.71-0.84). Diabetics also had lower adjusted post-operative complications compared to non-diabetics (aOR 0.82; 95% CI: 0.79-0.84). In uninsured individuals and patients <50 years of age, there was no protective association between diabetes and either in-hospital mortality or postoperative complications.

Conclusions: In patients undergoing colorectal cancer surgery, those with diabetes had a 23% lower mortality and fewer postoperative complications compared to non-diabetics. The mechanisms underlying this unexpected observation warrant further investigation.

Citing Articles

Influence of type II diabetes mellitus on postoperative complications following colorectal cancer surgery.

Popescu R, Leopa N, Dumitru E, Mitroi A, Tocia C, Dumitru A Exp Ther Med. 2022; 24(4):611.

PMID: 36160911 PMC: 9469087. DOI: 10.3892/etm.2022.11548.

Factors Associated With High Resource Use in Elective Adult Cardiac Surgery From 2005 to 2016.

Seo Y, Sareh S, Hadaya J, Sanaiha Y, Ziaeian B, Shemin R Ann Thorac Surg. 2021; 113(1):58-65.

PMID: 33689737 PMC: 8419207. DOI: 10.1016/j.athoracsur.2021.02.059.

Chemotherapy and adverse cardiovascular events in colorectal cancer patients undergoing surgical resection.

Koo C, Tai B, Chan D, Tan L, Tan K, Lee C World J Surg Oncol. 2021; 19(1):21.

PMID: 33478503 PMC: 7819286. DOI: 10.1186/s12957-021-02125-5.

The influence of diabetes on postoperative complications following colorectal surgery.

Tan D, Yaow C, Mok H, Ng C, Tai C, Tham H Tech Coloproctol. 2021; 25(3):267-278.

PMID: 33386511 PMC: 7775741. DOI: 10.1007/s10151-020-02373-9.

Improving outcome prediction in individuals with colorectal cancer and diabetes by accurate assessment of vascular complications: Implications for clinical practice.

Birch R, Downing A, Finan P, Howell S, Ajjan R, Morris E Eur J Surg Oncol. 2020; 47(5):999-1004.

PMID: 33168335 PMC: 8117971. DOI: 10.1016/j.ejso.2020.10.033.

References

Malone D, Genuit T, Tracy J, Gannon C, Napolitano L . Surgical site infections: reanalysis of risk factors. J Surg Res. 2002; 103(1):89-95. DOI: 10.1006/jsre.2001.6343. View

Chen S, Zhou Y, Wang H, Li S, Mao W, Wang H . [Risk factors of intra-abdominal infection following gastrectomy in gastric cancer patients]. Zhonghua Wei Chang Wai Ke Za Zhi. 2009; 12(2):137-40. View

Lee T, Marcantonio E, Mangione C, Thomas E, Polanczyk C, Cook E . Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100(10):1043-9. DOI: 10.1161/01.cir.100.10.1043. View

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View

Detsky A, Abrams H, Forbath N, Scott J, HILLIARD J . Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med. 1986; 146(11):2131-4. View

Bagdade J, Stewart M, Walters E . Impaired granulocyte adherence. A reversible defect in host defense in patients with poorly controlled diabetes. Diabetes. 1978; 27(6):677-81. DOI: 10.2337/diab.27.6.677. View

Kersten J, Schmeling T, Orth K, Pagel P, Warltier D . Acute hyperglycemia abolishes ischemic preconditioning in vivo. Am J Physiol. 1998; 275(2):H721-5. DOI: 10.1152/ajpheart.1998.275.2.H721. View

Detsky A, Abrams H, McLaughlin J, Drucker D, Sasson Z, Johnston N . Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med. 1986; 1(4):211-9. DOI: 10.1007/BF02596184. View

Gil-Bona J, Sabate A, Pi A, Adroer R, Jaurrieta E . [Mortality risk factors in surgical patients in a tertiary hospital: a study of patient records in the period 2004-2006]. Cir Esp. 2009; 85(4):229-37. DOI: 10.1016/j.ciresp.2008.10.002. View

10.

Griesdale D, de Souza R, van Dam R, Heyland D, Cook D, Malhotra A . Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009; 180(8):821-7. PMC: 2665940. DOI: 10.1503/cmaj.090206. View

11.

Lange C, Ploeg A, Lardenoye J, Breslau P . Patient- and procedure-specific risk factors for postoperative complications in peripheral vascular surgery. Qual Saf Health Care. 2009; 18(2):131-6. DOI: 10.1136/qshc.2007.022335. View

12.

Auerbach A, Rasic M, Sehgal N, Ide B, Stone B, Maselli J . Opportunity missed: medical consultation, resource use, and quality of care of patients undergoing major surgery. Arch Intern Med. 2007; 167(21):2338-44. DOI: 10.1001/archinte.167.21.2338. View

13.

Kern E, Maney M, Miller D, Tseng C, Tiwari A, Rajan M . Failure of ICD-9-CM codes to identify patients with comorbid chronic kidney disease in diabetes. Health Serv Res. 2006; 41(2):564-80. PMC: 1702507. DOI: 10.1111/j.1475-6773.2005.00482.x. View

14.

Haffner S, Lehto S, Ronnemaa T, Pyorala K, Laakso M . Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998; 339(4):229-34. DOI: 10.1056/NEJM199807233390404. View

15.

Goldman L, Caldera D, Nussbaum S, Southwick F, Krogstad D, Murray B . Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977; 297(16):845-50. DOI: 10.1056/NEJM197710202971601. View

16.

Jencks S . Accuracy in recorded diagnoses. JAMA. 1992; 267(16):2238-9. View

17.

Clement S, Braithwaite S, Magee M, Ahmann A, Smith E, Schafer R . Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004; 27(2):553-91. DOI: 10.2337/diacare.27.2.553. View

18.

Root H . Preoperative medical care of the diabetic patient. Postgrad Med. 1966; 40(4):439-44. DOI: 10.1080/00325481.1966.11695982. View

19.

Levetan C, Passaro M, Jablonski K, Kass M, Ratner R . Unrecognized diabetes among hospitalized patients. Diabetes Care. 1998; 21(2):246-9. DOI: 10.2337/diacare.21.2.246. View

20.

Joshi N, Caputo G, Weitekamp M, Karchmer A . Infections in patients with diabetes mellitus. N Engl J Med. 1999; 341(25):1906-12. DOI: 10.1056/NEJM199912163412507. View