Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy--a population-based study.
OBJECTIVE
to determine if diabetes mellitus is a risk factor for outcome after carotid endarterectomy (CEA).


METHODS
the outcome and complications of all vascular procedures performed in Sweden are registered prospectively in the Swedish Vascular Registry (Swedvasc) and form the basis of this report. During the 10-year period 1987-96 2622 CEAs were analysed for notified complications.


RESULTS
of the 2622 CEAs, 341 (13%) were performed on diabetics and 2281 (87%) on non-diabetics. Patients with diabetes presented at a younger age (67.1+/-8.3 years vs. 68.2+/-8.3 years p =0.028), were more likely to have a history of hypertension (61.9% vs. 50% p =0.001) and were less often smokers (34.9% vs. 43.2% p =0.001). Diabetics presented more often with minor stroke (41.3% vs. 30.8% p =0.002) and non-diabetics more often with amaurosis fugax (18.9% vs. 14.4% p =0.04). Diabetics had a higher 30-day mortality (3.2% vs. 1. 4% p =0.02). The 30-day neurologic and cardiac morbidity did not differ. The 1-year mortality was 7.9% in diabetics and 4.4% in non-diabetics (p =0.008). Non-diabetics operated on in 1992-96 compared to those operated on in 1987-91 had a significantly lower combined permanent stroke and death rate (3.7% vs. 5.7% p =0.05), a difference not found in diabetics (6.3% for 1987-92 and 6.8% for 1992-96; N.S).


CONCLUSIONS
diabetics had both a higher 30-day and 1-year mortality after CEA compared to non-diabetics, mainly because of cardiac complications. However, postoperative neurologic morbidity did not differ.
Ahari
A
A
Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
Bergqvist
D
D
Troëng
T
T
Elfström
J
J
Hedberg
B
B
Ljungström
K
K
Norgren
L
L
Ortenwall
P
P
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome