The influence of diabetes mellitus on the risk of abdominal aortic surgery.
Risk factors and postoperative complications of 153 diabetics (DM) who underwent an abdominal aortic operation for occlusive disease or an intact aneurysm from 1964 through June, 1988 were compared with 970 nondiabetics (nonDM) who underwent similar operations during the same time period. Heart disease, hypertension, cerebrovascular disease, and renal insufficiency were more prevalent in diabetics. Postoperatively, DM had a statistically significant increase in the incidence of myocardial infarction (DM 5.2%, nonDM 2.1%, P = .0434) and wound infection (DM 2.6%, nonDM 0.6%, P = .0359). The incidence of renal failure (DM 1.3%, nonDM 1.0%), stroke (DM 2.0%, nonDM 0.6%), and death (DM 3.9%, nonDM 2.9%) was higher in diabetics, but the differences were not statistically significant (P = NS). Operative mortality was greater for patients operated on for aneurysm (DM 5.3%, nonDM 3.2%) than for patients operated for occlusive disease (DM 3.3% versus nonDM 2.7%). Diabetics treated with insulin or oral agents had a higher complication rate than diabetics treated with diet alone or nondiabetics (insulin 13.0%, oral 13.4%, diet 4.2%, nonDM 8.6%). This study finds that diabetic patients can undergo an abdominal aortic operation with operative mortality comparable to that of nondiabetics. Diabetics have more postoperative complications than nondiabetics, but only myocardial infarction and wound infection are of statistical significance. Diabetics treated with insulin or oral agents have more complications than do diabetics treated by diet alone or nondiabetics.
Treiman
G S
GS
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Treiman
R L
RL
Foran
R F
RF
Cossman
D V
DV
Cohen
J L
JL
Levin
P M
PM
Wagner
W H
WH
Davidson
M B
MB
D000368:Aged; D001012:Aorta, Abdominal; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome