Postoperative adverse events in patients with diabetes undergoing orthopedic and general surgery

• Published in: Medicine (Baltimore) Vol. 98; no. 14; p. e15089
• Main Authors: Wang, Jinjing, Chen, Kang, Li, Xueqiong, Jin, Xinye, An, Ping, Fang, Yi, Mu, Yiming
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.04.2019
• Subjects: Aged; Case-Control Studies; Diabetes Complications - epidemiology; Diabetes Mellitus - epidemiology; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - statistics & numerical data; Female; Humans; Incidence; Male; Middle Aged; Observational Study; Orthopedic Procedures - adverse effects; Orthopedic Procedures - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - mortality; Regression Analysis; Retrospective Studies; Risk Factors
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000015089

Factors that may result in the occurrence of adverse clinical events in diabetic patients during the postoperative period are not entirely clear. This study evaluated factors that may cause adverse events following elective orthopedic or general surgery.Patients with diabetes who underwent orthopedic or general surgery between January 2010 and October 2015 were retrospectively selected from the General Hospital of People's Liberation Army database. Factors associated with postoperative adverse events were analyzed using multivariable logistic regression.Among 1525 patients included, mean age was 63.5 ± 10.8 years and mean duration of diabetes was 8.8 ± 6.6 years. Among them, 49.9% underwent orthopedic surgery and 50.1% underwent general surgery. Postoperatively, 118 (7.7%) patients had adverse events, including delayed extubation (n = 43, 36.4%), circulatory disorder (n = 15, 12.7%), respiratory and circulatory abnormalities (n = 23, 19.5%), nonhealing of the incision (n = 11, 9.3%), infections at other sites (n = 15, 12.7%), other complications (n = 8, 6.8%), and death (n = 3, 2.5%). Multivariable regression analysis showed that age >65 years old [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.25-3.98], male sex (OR = 2.14, 95% CI: 1.24-3.38), postoperative peripheral blood glucose (OR = 1.13, 95% CI: 1.13-1.82), diabetic complications (OR = 2.41, 95% CI: 1.36-4.28), abnormal kidney function (OR = 2.73, 95% CI: 1.13-6.58) and general surgery (OR = 1.48, 95% CI: 1.11-5.26) were associated with the occurrence of postoperative adverse events.In patients with diabetes undergoing intermediate or major elective surgery, older age, male sex, high postoperative peripheral blood glucose, diabetic complications, abnormal kidney function, and general surgery type were associated with the occurrence of postoperative adverse events.