%0 Journal Article
%T Outcomes of Diabetic and Nondiabetic Patients Undergoing General and Vascular Surgery
%A Stephen Serio
%A John M. Clements
%A Dawn Grauf
%A Aziz M. Merchant
%J ISRN Surgery
%D 2013
%R 10.1155/2013/963930
%X Aims. Preoperative diabetic and glycemic screening may or may not be cost effective. Although hyperglycemia is known to compromise surgical outcomes, the effect of a diabetic diagnosis on outcomes is poorly known. We examine the effect of diabetes on outcomes for general and vascular surgery patients. Methods. Data were collected from the Michigan Surgical Quality Collaborative for general or vascular surgery patients who had diabetes. Primary and secondary outcomes were 30-day mortality and 30-day overall morbidity, respectively. Binary logistic regression analysis was used to identify risk factors. Results. We identified 177,430 (89.9%) general surgery and 34,006 (16.1%) vascular surgery patients. Insulin and noninsulin diabetics accounted for 7.1% and 9.8%, respectively. Insulin and noninsulin dependent diabetics were not at increased risk for mortality. Diabetics are at a slight increased odds than non-diabetics for overall morbidity, and insulin dependent diabetics more so than non-insulin dependent. Ventilator dependence, 10% weight loss, emergent case, and ASA class were most predictive. Conclusions. Diabetics were not at increased risk for postoperative mortality. Insulin-dependent diabetics undergoing general or vascular surgery were at increased risk of overall 30-day morbidity. These data provide insight towards mitigating poor surgical outcomes in diabetic patients and the cost effectiveness of preoperative diabetic screening. 1. Introduction The national diabetes epidemic continues to expand, with about 1.6 million new cases each year and an overall prevalence of 23.6 million people. Additional 57 million American adults are at high risk for type 2 diabetes mellitus (T2DM) [1]. The annual diagnosed diabetes incidence is projected to almost double from 8 cases per 1,000 in 2008 to about 15 in 1,000 by 2050, with a potential total prevalence projected to increase one-fifth of the US population by 2050 [2]. Currently, 10% of Americans have T2DM, and 20% to 25% are considered prediabetic with impaired glucose tolerance and elevated fasting glucose measurements [3]. The long-term complications of uncontrolled hyperglycemia in diabetics include neuropathy, nephropathy, retinopathy, and other chronic issues. The in-hospital morbidity of diabetics and new-onset hyperglycemics is well documented. Umpierrez et al. showed that for inpatients with new hyperglycemia or known diabetes there was a higher in-hospital mortality, increased length of stay, increased intensive care unit (ICU) stay, increased transitional or nursing home care, a higher rate of
%U http://www.hindawi.com/journals/isrn.surgery/2013/963930/