Is diabetes a risk factor for patients undergoing open abdominal aortic aneurysm repair?
A number of studies have compared results after aortic procedures in diabetics vs nondiabetics but few have focused specifically on abdominal aortic aneurysm surgery. An analysis of prospective data was carried out in the Vascular Surgery Registry (Beth Israel Deaconess Medical Center, Boston, MA) and identified 421 patients (422 grafts) who underwent elective open repair of an abdominal aortic aneurysm between 1990 and 1999. The influence of diabetes mellitus on outcome was assessed by dividing the patients into two groups: 52 diabetic and 370 nondiabetic patients. Postoperative mortality was 1.7% overall (n = 7) and proportionally higher in the diabetic population, although this did not reach statistical significance (3.8% vs 1.4%, p = 0.19). However, cumulative survival at 1 year and 3 years was essentially identical for diabetic vs nondiabetic patients (91.0% vs 92.6% and 70.0% vs 73.5%, respectively) and did not diverge until 5 years after surgery (25.0% vs 50.9% respectively [p > 0.05]). Overall, major complications occurred in 11 diabetics (21.2%) vs 58 nondiabetics (15.7%, p = 0.32). Specific complications that were increased in the diabetic population included pancreatitis (5.8% vs 1.1%, p = 0.01) and pneumonia (11.5% vs 3.2%, p = 0.006). Notably, overall cardiac morbidity was not higher in patients with diabetes mellitus (1.9% vs 4.3%, p = 0.41). Our data suggest that after elective open abdominal aortic aneurysm repair, patients with diabetes mellitus may have a higher rate of certain complications when compared to patients without diabetes mellitus. These differences however, do not preclude the expectation of excellent results of open abdominal aortic aneurysm repair in patients with diabetes mellitus.
Rayan
Sunil S
SS
Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
Hamdan
Allen D
AD
Campbell
David R
DR
Akbari
Cameron M
CM
Hook
Shannon C
SC
Skillman
John
J
LoGerfo
Frank W
FW
Pomposelli
Frank B
FB
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate