Mortality in diabetic patients undergoing non-cardiac surgery: a 7-year follow-up study.
BACKGROUND
The prognosis of diabetic patients after non-cardiac surgery remains controversial. This study was designed to compare the long-term mortality between diabetic and non-diabetic control patients undergoing non-cardiac surgery and to evaluate the possible risk factors.


METHODS
We investigated 274 consecutive diabetic patients and 282 non-diabetic control patients who underwent non-cardiac surgery within 1 year in a tertiary care hospital in Finland. The control group was matched for the same type of operations. Patients were followed for up to 7 years on average. The main outcome measure was mortality within 7 years.


RESULTS
Mortality both in the short-term postoperatively (< or =21 days) and in the long-term (up to 87 (1/2) months) was significantly higher in the diabetic patients compared with the non-diabetic group: 3.5 vs. 0% (P<0.05) and 37.2 vs. 15% (P<0.00001), respectively. The major causes of death among diabetic subjects were diseases of the cardiovascular system (56.8%) compared with non-diabetic patients (18.6%), P<0.0001. We found that diabetes mellitus per se is not a risk factor for post-operative mortality but a combination of variables had a significant effect on both short- and long-term mortality.


CONCLUSIONS
Diabetic patients undergoing non-cardiac surgery had a significantly higher incidence of short-term post-operative and long-term mortality compared with non-diabetic subjects. We propose a model of predictors of death among diabetic individuals undergoing non-cardiac surgery within a 7-year follow-up. The majority of deaths were associated with cardiovascular diseases.
Krolikowska
M
M
Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital/Jorvi Hospital, Espoo, Finland. magdalena.krolikowska@hus.fi
Kataja
M
M
Pöyhiä
R
R
Drzewoski
J
J
Hynynen
M
M
D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D016019:Survival Analysis
D006442:Glycated Hemoglobin