Diabetes Mellitus with Chronic Complications in Relation to Carotid Endarterectomy and Carotid Artery Stenting Outcomes

• Published in: Journal of stroke and cerebrovascular diseases Vol. 26; no. 1; pp. 217 - 224
• Main Authors: Adegbala, Oluwole, MPH, Martin, Kimberly D., PhD, Otuada, David, PhD, Akinyemiju, Tomi, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Aged; Aged, 80 and over; Cardiovascular; carotid artery; carotid endarterectomy; Carotid Stenosis - complications; Carotid Stenosis - epidemiology; Carotid Stenosis - surgery; Diabetes mellitus; Diabetes Mellitus - epidemiology; Endarterectomy, Carotid - adverse effects; Female; hospitalization outcomes; Humans; Male; Middle Aged; mortality; Myocardial Infarction - etiology; Neurology; Odds Ratio; Outcome Assessment (Health Care); Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Risk Assessment; stenting; Stents - adverse effects; United States - epidemiology; mortality; carotid endarterectomy; hospitalization outcomes; carotid artery; Diabetes mellitus; stenting
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.012

Background Carotid endarterectomy and carotid artery stenting are effective treatment procedures for carotid artery stenosis. Although diabetes mellitus is highly prevalent among patients undergoing these revascularization procedures, few studies have examined their impact on periprocedural outcomes. Objectives The study aimed to determine whether perioperative outcomes among patients undergoing carotid artery stenting and carotid endarterectomy varied depending on the presence of diabetes with or without chronic complications. Methods We examined adults aged 45 and above hospitalized between 2007 and 2011 in U.S. hospitals who underwent carotid artery revascularization procedures. We used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample and evaluated the influence of diabetes with or without chronic complications on outcomes. Results Among patients receiving carotid artery stenting, diabetic patients with chronic complications had significantly increased odds of acute kidney injury (odds ratio [OR]: 3.17, 95% confidence interval [CI]: 2.31-4.35) and longer hospital stay (β: 1.98, 95% CI: 1.58-2.38) compared with nondiabetic patients. Diabetic patients with chronic complications receiving carotid endarterectomy experienced increased odds of myocardial infarction (OR: 1.12, 95% CI: .90-1.40), stroke (OR: 1.29, 95% CI: .97-1.72), perioperative infection (OR: 2.45, 95% CI: 1.29-4.65), mortality (OR: 1.48, 95% CI: 1.01-2.16), and longer hospital stay (β (days): 2.05, 95% CI: 1.90-2.20) compared with nondiabetic patients. No significant increased odds of perioperative outcomes were observed among diabetic patients without chronic complications. Conclusions Uncomplicated diabetes did not appear to convey a higher odds of perioperative outcomes among patients undergoing revascularization. However, the presence of diabetes with chronic complications is an important risk factor in the carotid endarterectomy category.