title: Neither diabetes nor glucose-lowering drugs are associated with mortality after noncardiac surgery in patients with coronary artery disease or heart failure.
abstract: BACKGROUND
  It is unclear whether diabetes mellitus or use of particular glucose-lowering agents is associated with increased risk of mortality after noncardiac surgery in patients with known cardiac disease.
  
  
  METHODS
  We carried out a retrospective cohort study using 4 linked administrative databases in the province of Alberta, Canada from 1999-2006.
  
  
  RESULTS
  Of the 32,834 patients with known cardiac disease in our cohort, 9305 (28%) had diabetes. All-cause 30-day mortality after noncardiac surgery was 6.4% in patients with diabetes, and 6.1% in those without diabetes (multivariate adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI], 0.87-1.08). In the 24,037 patients older than 65, mortality was 7.5% in individuals with diabetes and 7.5% in those without diabetes (5.7% in those taking insulin [aOR, 0.89; 95% CI, 0.70-1.13], 8.0% in those using oral agents only [aOR, 1.08; 95% CI, 0.95-1.22]). None of the glucose-lowering drug classes were associated with perioperative mortality in elderly cardiac patients (sulfonylureas aOR, 0.94; 95% CI, 0.76-1.16; metformin aOR, 0.92; 95% CI, 0.74-1.14; thiazolidinediones aOR, 0.64; 95% CI, 0.40-1.04; insulin aOR, 0.83; 95% CI, 0.65-1.08), but use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (aOR, 0.83; 95% CI, 0.75-0.93), β-blockers (aOR, 0.82; 95% CI, 0.72-0.93), or statins (aOR, 0.65; 95% CI, 0.55-0.78) in the 100 days before surgery were associated with lower 30-day mortality.
  
  
  CONCLUSIONS
  Neither diabetes nor exposure to common classes of glucose-lowering drugs preoperatively were associated with increased perioperative mortality in cardiac patients undergoing noncardiac surgery. However, cardiac patients not using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, or statins preoperatively exhibited higher mortality rates, emphasizing the importance of optimizing evidence-based therapy before elective surgery in these patients.
authors.affiliation: Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
authors.forename: Mikael
authors.initials: M
authors.lastname: Hanninen
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bakal
authors.forename: Sean
authors.initials: S
authors.lastname: van Diepen
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D004396:Coloring Agents / Q000627:therapeutic use; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality*; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013514:Surgical Procedures, Operative / Q000401:mortality*; D045162:Thiazolidinediones / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004396:Coloring Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D008687:Metformin