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Diabetes Does Not Increase In-hospital or Short-term Mortality in Patients Undergoing Surgical Repair for Type A Aortic Dissection: Insight from the National Readmission Database

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Abstract

Background: Previous studies have reported a protective effect of type 2 diabetes on the incidence and progression of aortic aneurysms. We investigated whether this protective effect extends to aortic dissections.

Methods: Data from the US Nationwide Readmission Database (2016-2019) were analyzed. Patients admitted for open surgery repair of acute type A aortic dissection (TAAD) were initially analyzed (index group). Those discharged alive were followed for up to 30 days (readmission group). The co-primary outcomes were in-hospital and 30-day mortality.

Results: Between 2016 and 2019, 7,324 patients were admitted for open surgical repair of acute TAAD, of whom 965 (13.2%) had diabetes. Patients with diabetes were older and had a higher prevalence of obesity, hypertension, smoking, dyslipidemia, and chronic kidney disease (CKD). 15.2% of patients with diabetes and 14.6% without diabetes died; hence, diabetes did not have a significant impact on in-hospital mortality (adjusted odd ratio [aOR] = 1.02 [0.84-1.24]). Similarly, diabetes was not associated with a higher adjusted risk of atrial fibrillation (aOR = 1.03 [0.89-1.20]), stroke (aOR = 0.83 [0.55-1.26]), cardiogenic shock (aOR = 1.18 [0.98-1.42]), but increased the risk of acute renal failure (aOR = 1.20 [1.04-1.39]). Within 30 days of discharge, 154 (15.9%) patients with diabetes and 952 (15%) from the non-diabetes group were readmitted. Readmitted patients with diabetes were older and had a higher prevalence of cardiovascular comorbidities. We didn't observe any significant difference in the adjusted risk of 30-day mortality between the diabetes and non-diabetes groups (adjusted hazard ratio [aHR] = 0.81 [0.41-1.60]). However, diabetes was associated with a lower risk of readmission (aHR = 0.81 [0.68-0.97]). Age was the most significant predictor of all outcomes. CKD was the most significant predictor of 30-day mortality, with the risk increasing five-fold in patients with diabetes (HR = 5.58 [2.58-6.62]. Cardiovascular-related conditions were the most common causes of readmission in both groups. However, respiratory-related conditions were more prevalent in the diabetes group compared to the non-diabetes group (19.5% vs. 13%, respectively, p = 0.032).

Conclusions: Diabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for Type A aortic dissection.

References
1.
Smith D, Thorp M, Gurwitz J, McManus D, Goldberg R, Allen L . Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study. Circ Cardiovasc Qual Outcomes. 2013; 6(3):333-42. PMC: 3904800. DOI: 10.1161/CIRCOUTCOMES.113.000221. View

2.
Chen S, Chan Y, Lin C, Wu V, Cheng Y, Chen D . Association of Long-term Use of Antihypertensive Medications With Late Outcomes Among Patients With Aortic Dissection. JAMA Netw Open. 2021; 4(3):e210469. PMC: 7930924. DOI: 10.1001/jamanetworkopen.2021.0469. View

3.
Visca D, Pignatti P, Spanevello A, Lucini E, La Rocca E . Relationship between diabetes and respiratory diseases-Clinical and therapeutic aspects. Pharmacol Res. 2018; 137:230-235. DOI: 10.1016/j.phrs.2018.10.008. View

4.
Bower W, Jin L, Underwood M, Lee J, Lee K, Lam Y . Overt diabetes mellitus adversely affects surgical outcomes of noncardiovascular patients. Surgery. 2010; 147(5):670-5. DOI: 10.1016/j.surg.2009.10.070. View

5.
Yan A, Koh M, Chan K, Guo H, Alter D, Austin P . Association Between Cardiovascular Risk Factors and Aortic Stenosis: The CANHEART Aortic Stenosis Study. J Am Coll Cardiol. 2017; 69(12):1523-1532. DOI: 10.1016/j.jacc.2017.01.025. View