Diabetes mellitus and increased postoperative risk of acute renal failure after hepatectomy for hepatocellular carcinoma: a nationwide population-based study.
BACKGROUND
This study aimed to determine the effects of diabetes mellitus (DM) on the risk of surgical mortality and morbidity in patients undergoing hepatectomy for hepatocellular carcinoma (HCC).


METHODS
We identified 2,962 DM patients who underwent a hepatectomy for HCC from 2000 to 2010. The non-DM control cohort consisted of 2,962 patients who also received a hepatectomy during the same period. Age, sex, comorbidities, and year of admission were all matched between the 2 cohorts.


RESULTS
The prevalence of preoperative coexisting medical conditions was comparable between the DM and non-DM cohorts, except the percentage of patients undergoing major hepatectomy (lobectomy; 18.1 % in the DM cohort vs. 20.4 % in the non-DM cohort; p = 0.02).The hazard ratio (HR) of 30-day postoperative mortality in the DM patients after hepatectomy was 1.17 [95 % confidence interval (CI) 0.75-1.84] after adjustment. The DM cohort exhibited a significantly higher risk of postoperative septicemia (adjusted hazard ratio, 1.45; 95 % CI 1.06-2.00) and acute renal failure (adjusted hazard ratio, 1.70; 95 % CI 1.01-2.84) compared with that of the non-DM cohort, but this higher risk was not associated with the increased risk of other major morbidities, including pneumonia, stroke, and myocardial infarction. Further analysis showed that major hepatectomy (lobectomy) in DM patients carried higher risks of septicemia and acute renal failure. In multiple regression models, preoperative diabetes-related comorbidities were not significantly associated with 30-day postoperative mortality.


CONCLUSIONS
DM is associated with a significantly high risk of septicemia and acute renal failure, but not with other major complications or mortality, after hepatectomy for HCC.
Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan.
Ming-Shian
MS
Tsai
Cheng-Li
CL
Lin
Shih-Ni
SN
Chang
Po-Huang
PH
Lee
Chia-Hung
CH
Kao
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology