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The Presence of Diabetes and Higher HbA 1c Are Independently Associated With Adverse Outcomes After Surgery.
- Source :
-
Diabetes care [Diabetes Care] 2018 Jun; Vol. 41 (6), pp. 1172-1179. Date of Electronic Publication: 2018 Mar 26. - Publication Year :
- 2018
-
Abstract
- Objective: Limited studies have examined the association between diabetes and HbA <subscript>1c</subscript> with postoperative outcomes. We investigated the association of diabetes, defined categorically, and the association of HbA <subscript>1c</subscript> as a continuous measure, with postoperative outcomes.<br />Research Design and Methods: In this prospective, observational study, we measured the HbA <subscript>1c</subscript> of surgical inpatients age ≥54 years at a tertiary hospital between May 2013 and January 2016. Patients were diagnosed with diabetes if they had preexisting diabetes or an HbA <subscript>1c</subscript> ≥6.5% (48 mmol/mol) or with prediabetes if they had an HbA <subscript>1c</subscript> between 5.7 and 6.4% (39 and 48 mmol/mol). Patients with an HbA <subscript>1c</subscript> <5.7% (39 mmol/mol) were categorized as having normoglycemia. Baseline demographic and clinical data were obtained from hospital records, and patients were followed for 6 months. Random-effects logistic and negative binomial regression models were used for analysis, treating surgical units as random effects. We undertook classification and regression tree (CART) analysis to design a 6-month mortality risk model.<br />Results: Of 7,565 inpatients, 30% had diabetes, and 37% had prediabetes. After adjusting for age, Charlson comorbidity index (excluding diabetes and age), estimated glomerular filtration rate, and length of surgery, diabetes was associated with increased 6-month mortality (adjusted odds ratio [aOR] 1.29 [95% CI 1.05-1.58]; P = 0.014), major complications (1.32 [1.14-1.52]; P < 0.001), intensive care unit (ICU) admission (1.50 [1.28-1.75]; P < 0.001), mechanical ventilation (1.67 [1.32-2.10]; P < 0.001), and hospital length of stay (LOS) (adjusted incidence rate ratio [aIRR] 1.08 [95% CI 1.04-1.12]; P < 0.001). Each percentage increase in HbA <subscript>1c</subscript> was associated with increased major complications (aOR 1.07 [1.01-1.14]; P = 0.030), ICU admission (aOR 1.14 [1.07-1.21]; P < 0.001), and hospital LOS (aIRR 1.05 [1.03-1.06]; P < 0.001). CART analysis confirmed a higher risk of 6-month mortality with diabetes in conjunction with other risk factors.<br />Conclusions: Almost one-third of surgical inpatients age ≥54 years had diabetes. Diabetes and higher HbA <subscript>1c</subscript> were independently associated with a higher risk of adverse outcomes after surgery.<br /> (© 2018 by the American Diabetes Association.)
- Subjects :
- Aged
Aged, 80 and over
Diabetes Complications blood
Diabetes Complications epidemiology
Female
Glycated Hemoglobin analysis
Hospitalization statistics & numerical data
Humans
Inpatients
Intensive Care Units
Length of Stay statistics & numerical data
Male
Middle Aged
Postoperative Complications blood
Postoperative Period
Prediabetic State blood
Prediabetic State epidemiology
Risk Factors
Diabetes Mellitus blood
Diabetes Mellitus epidemiology
Glycated Hemoglobin metabolism
Postoperative Complications epidemiology
Surgical Procedures, Operative adverse effects
Surgical Procedures, Operative statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1935-5548
- Volume :
- 41
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Diabetes care
- Publication Type :
- Academic Journal
- Accession number :
- 29581095
- Full Text :
- https://doi.org/10.2337/dc17-2304