title: Insulin-Treated Patients with Diabetes Mellitus Undergoing Emergency Abdominal Surgery Have Worse Outcomes than Patients Treated with Oral Agents.
abstract: BACKGROUND
  Diabetes mellitus (DM) is a known risk factor for worse outcomes after emergency abdominal surgery (EAS). However, it is unclear if the type of diabetes treatment (insulin or oral agents) has any effect on outcomes after EAS.
  
  
  METHODS
  Matched cohort study utilizing the ACS NSQIP database. Patients with DM undergoing EAS were divided into insulin and oral agent treatment groups. A 1:1 cohort matching of insulin-treated and oral agent-treated patients was performed (matched for sex, age, ASA score, BMI category, operative procedure, and preoperative acute renal failure, pneumonia, SIRS, sepsis, septic shock, and corticosteroid use). Outcomes of matched insulin- and oral agent-treated patients were compared with univariable and multivariable regression analysis.
  
  
  RESULTS
  A total of 7401 patients with DM underwent EAS, 3182 (43 %) of which were insulin treated and 4219 (57 %) were treated with oral agents. Matching resulted in 2280 matched cases, which formed the basis of this analysis. Insulin-treated patients were more likely to have postoperative complications (OR 1.279, CI 1.119-1.462), had a higher 30-day mortality rate in patients with sepsis at hospital admission (OR 3.421, CI 1.959-5.974), and a longer total hospital length of stay (RC 1.115, CI 1.065-1.168) and postoperative LOS (RC 1.082, CI 1.031-1.135).
  
  
  CONCLUSIONS
  In patients with DM undergoing emergency abdominal surgery, insulin-treated patients have worse outcomes than oral agent-treated patients. Insulin-treated patients with DM therefore should be monitored and treated more intensively in anticipation of potential complications after emergency abdominal surgery.
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Haltmeier
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
authors.affiliation: Division of Endocrinology, Department of Medicine, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Beale
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA. demetria@usc.edu.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy*; D004630:Emergencies; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*
chemical_list: D007328:Insulin