Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery
Background and objective: The prognosis of diabetic patients after surgery remains controversial. Some suggest that the rates of death and complications today are almost identical in diabetic and non-diabetic patients within hospital stay or for 30 days postoperatively, whereas others suggest that diabetes still constitutes a major risk factor for both short-term ([less-than-or-equal]30 days) and long-term (>30 days) patients especially after major cardiac surgery. We examined the long-term postoperative mortality of diabetic patients undergoing major non-cardiac surgery to identify possible perioperative risk factors.
Methods: Data from 179 consecutive diabetic patients, who underwent major non-cardiac surgery at Herlev Hospital, Denmark, during a 12 month period, have been retrospectively analysed. Data were obtained from patient records and from The Danish National Health Register. The main outcome measure was postoperative mortality. Patients were followed for a maximum of 18 months.
Results: The median postoperative observation period was 10 months (range 0–18 months). Overall postoperative mortality was 24% (95% confidence interval (CI) 17–31%). One third of the fatalities occurred during the first 30 days. Ischaemic heart disease diagnosed before the operation was associated with an overall postoperative mortality of 44% (95% CI 29–58%), which was significantly (P < 0.03) higher than in diabetic patients without known cardiovascular disease. The major causes of death in 18 out of 39 (46%) patients were diseases of the cardiovascular system.
Conclusions: Diabetic patients undergoing major non-cardiac surgery seem to have a high mortality, often because of cardiovascular death. Future strategies should focus on implementing cardio-protective treatment during the perioperative period.(Accepted December 2003)
Key Words: CARDIOVASCULAR DISEASES; GLUCOSE METABOLISM DISORDERS, DIABETES MELLITUS; MORTALITY; SURGERY.
c1 Correspondence to: Anne Benedicte Juul, Department 7102, Centre for Clinical Intervention Research, Copenhagen Trial Unit, Copenhagen University Hospital, H:S Rigshospitalet, DK-2100 Copenhagen, Denmark. E-mail: firstname.lastname@example.org; Tel: +45 3545 7156/3526 7235; Fax: +45 3545 7101