title: Insulin dependence as an independent predictor of perioperative morbidity after ventral hernia repair: a National Surgical Quality Improvement Program analysis of 45,759 patients.
abstract: BACKGROUND
  Although diabetes mellitus has been identified as a predictor of perioperative morbidity after ventral hernia repair (VHR), it is unclear whether insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) confer the same degree of risk. We examined the variable effect of IDDM and NIDDM on 30-day medical and surgical complications after VHR.
  
  
  METHODS
  We performed a retrospective analysis of patients in the National Surgical Quality Improvement Program database from 2005 to 2012 undergoing VHR. After perioperative variable comparison, regression analysis was performed to determine whether IDDM and/or NIDDM independently predicted increased complications after proper risk adjustment.
  
  
  RESULTS
  A total of 45,759 patients were identified to have undergone VHR. Of these, 38,026 patients (83.1%) were not diabetic, 5,252 (11.5%) were NIDDM patients, and 2,481 (5.4%) were IDDM patients. After controlling for other risk factors, we found that IDDM independently predicted increased rates of overall, surgical, and medical complications (odds ratio, 1.284, 1.251, 1.263, respectively) in open repair. IDDM independently predicted increased overall and medical complications (odds ratio, 1.997, 1.889, respectively) but not surgical complications in laparoscopic repair. NIDDM was not significantly associated with any complication type in either procedure type.
  
  
  CONCLUSIONS
  Our present study suggests that much of the perioperative risk associated with diabetes is attributable to IDDM. The effect of IDDM on laparoscopic and open repair is subtly different. IDDM demonstrates increased overall and medical complications in laparoscopic repair and increased overall, medical, and surgical complications in open repair. Of note, IDDM does not independently predict increased risk for surgical complications in laparoscopic repair.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Qin
authors.affiliation: Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Souza
authors.affiliation: Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611, USA.
authors.forename: Apas
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611, USA. Electronic address: jokim@nmh.org.
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Diabetes mellitus; Insulin-dependent diabetes mellitus; Non–insulin-dependent diabetes mellitus; Ventral hernia repair