Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery.
OBJECTIVE
The prognosis of diabetic patients after surgery remains controversial. Some suggest that the rates of death and complications today are almost identical in diabetic and non-diabetic patients within hospital stay or for 30 days postoperatively, whereas others suggest that diabetes still constitutes a major risk factor for both short-term (< or = 30 days) and long-term (> 30 days) patients especially after major cardiac surgery. We examined the long-term postoperative mortality of diabetic patients undergoing major non-cardiac surgery to identify possible perioperative risk factors.


METHODS
Data from 179 consecutive diabetic patients, who underwent major non-cardiac surgery at Herlev Hospital, Denmark, during a 12 month period, have been retrospectively analysed. Data were obtained from patient records and from The Danish National Health Register. The main outcome measure was postoperative mortality. Patients were followed for a maximum of 18 months.


RESULTS
The median postoperative observation period was 10 months (range 0-18 months). Overall postoperative mortality was 24% (95% confidence interval (CI) 17-31%). One third of the fatalities occurred during the first 30 days. Ischaemic heart disease diagnosed before the operation was associated with an overall postoperative mortality of 44% (95% CI 29-58%), which was significantly (P < 0.03) higher than in diabetic patients without known cardiovascular disease. The major causes of death in 18 out of 39 (46%) patients were diseases of the cardiovascular system.


CONCLUSIONS
Diabetic patients undergoing major non-cardiac surgery seem to have a high mortality, often because of cardiovascular death. Future strategies should focus on implementing cardio-protective treatment during the perioperative period.
Copenhagen University Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7102, Rigshospitalet, Copenhagen, Denmark. anne.j@ctu.rh.dk
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Juul
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Wetterslev
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Kofoed-Enevoldsen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality