Risk Factors for Anastomotic Leak and Mortality in Diabetic Patients Undergoing Colectomy: Analysis From a Statewide Surgical Quality Collaborative

• Published in: Archives of surgery (Chicago. 1960) Vol. 147; no. 7; pp. 600 - 605
• Main Authors: Ziegler, Matthew A, Catto, James A, Riggs, Thomas W, Gates, Elizabeth R, Grodsky, Marc B, Wasvary, Harry J
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.07.2012
• Subjects: Aged; Anastomotic Leak - etiology; Anastomotic Leak - mortality; Biological and medical sciences; Chi-Square Distribution; Colectomy - adverse effects; Colectomy - mortality; Diabetes; Diabetes Mellitus - mortality; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Humans; Hyperglycemia; Laparoscopy; Laparotomy; Logistic Models; Male; Medical sciences; Michigan - epidemiology; Middle Aged; Mortality; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Statistics, Nonparametric; Steroids; Surgical outcomes; Michigan; Endocrinopathy; Human; Digestive system; Diabetes mellitus; Mortality; Gut; Leak; Patient; Colectomy; Epidemiology; Medicine; Treatment; Surgery; Quality; Risk factor; Colon
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.2012.77

OBJECTIVES To determine the risk factors in diabetic patients that are associated with increased postcolectomy mortality and anastomotic leak. DESIGN A prospectively acquired statewide database of patients who underwent colectomy was reviewed. Primary risk factors were diabetes mellitus, hyperglycemia (glucose level ≥140 mg/dL), steroid use, and emergency surgery. Categorical analysis, univariate logistic regression, and multivariate regression were used to evaluate the effects of these risk factors on outcomes. SETTING Participating hospitals within the Michigan Surgical Quality Collaborative. PATIENTS Database review of patients from hospitals within the Michigan Surgical Quality Collaborative. MAIN OUTCOME MEASURES Anastomotic leak and 30-day mortality rate. RESULTS Of 5123 patients, 153 (3.0%) had leaks and 153 (3.0%) died. Preoperative hyperglycemia occurred in 15.6% of patients, only 54% of whom were known to have diabetes. Multivariate analysis showed that the risk of leak for patients with and without diabetes increased only by preoperative steroid use (P < .05). Mortality among diabetic patients was associated with emergency surgery (P < .01) and anastomotic leak (P < .05); it was not associated with hyperglycemia. Mortality among nondiabetic patients was associated with hyperglycemia (P < .005). The presence of an anastomotic leak was associated with increased mortality among diabetic patients (26.3% vs 4.5%; P < .001) compared with nondiabetic patients (6.0% vs 2.5%; P < .05). CONCLUSIONS The presence of diabetes did not have an effect on the presence of an anastomotic leak, but diabetic patients who had a leak had more than a 4-fold higher mortality compared with nondiabetic patients. Preoperative steroid use led to increased rates of anastomotic leak in diabetic patients. Mortality was associated with hyperglycemia for nondiabetic patients only. Improved screening may identify high-risk patients who would benefit from perioperative intervention.