title: Diabetes Mellitus in Patients Presenting with Adhesive Small Bowel Obstruction: Delaying Surgical Intervention Results in Worse Outcomes.
abstract: BACKGROUND
  The impact of diabetes mellitus (DM) on outcomes in patients undergoing emergency laparotomy for adhesive small bowel obstruction (ASBO) remains unknown.
  
  
  METHODS
  Low-risk (ASA class of I and II) patients requiring emergency operation for ASBO were identified using the ACS NSQIP database. Propensity score matching was used to match patients with DM to those without DM in a ratio of 1:3. Mortality, infectious complications, acute renal failure (ARF), and myocardial infarction (MI) were compared between the two groups. The impact of delaying OR ≥ 24 h was also analyzed in the two groups.
  
  
  RESULTS
  A total of 1,608 patients were matched, 402 with DM and 1,204 without DM. Overall, patients with DM were significantly more likely to develop infections, ARF and MI. Diabetes had no negative impact on outcomes if the operation was performed within 24 h of admission. However, delaying surgery >24, significantly increased infections, ARF and MI.
  
  
  CONCLUSIONS
  DM in low-risk patients has no negative impact on outcomes in patients undergoing surgery for ASBO within 24 h. However, delaying surgery >24 h resulted in worse outcomes.
authors.affiliation: Department of Surgery, Henry Ford Hospital/Wayne State University, Detroit, MI, USA.
authors.forename: Efstathios
authors.initials: E
authors.lastname: Karamanos
authors.affiliation: Department of Surgery, Henry Ford Hospital/Wayne State University, Detroit, MI, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Dulchavsky
authors.affiliation: Department of Endocrinology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Beale
authors.affiliation: Division of Trauma, Acute Care Surgery and Surgical Critical Care, University of Southern California, 2051 Marengo Street, Los Angeles, CA, USA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Trauma, Acute Care Surgery and Surgical Critical Care, University of Southern California, 2051 Marengo Street, Los Angeles, CA, USA. demetria@usc.edu.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004630:Emergencies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D000267:Tissue Adhesions / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome