European Journal of Anaesthesiology



Original Article

Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery


A. B. Juul a1c1, J. Wetterslev a2 and A. Kofoed-Enevoldsen a3
a1 Copenhagen University Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7102, Rigshospitalet, Copenhagen, Denmark
a2 University Hospital of Copenhagen, Department of Anaesthesiology, Herlev, Denmark
a3 Esbjerg Varde Hospital, Department of Internal Medicine, Esbjerg, Denmark

Article author query
juul ab   [PubMed][Google Scholar] 
wetterslev j   [PubMed][Google Scholar] 
kofoed-enevoldsen a   [PubMed][Google Scholar] 

Summary

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.

Correspondence:
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: anne.j@ctu.rh.dk; Tel: +45 3545 7156/3526 7235; Fax: +45 3545 7101