Lin Chao-Shun, Chang Chuen-Chau, Lee Yuan-Wen, Liu Chih-Chung, Yeh Chun-Chieh, Chang Yi-Cheng, Chuang Ming-Tsang, Chang Tzu-Hao, Chen Ta-Liang, Liao Chien-Chang
Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan.
J Clin Med. 2019 Jan 16;8(1):100. doi: 10.3390/jcm8010100.
The impact of diabetes on perioperative outcomes remains incompletely understood. Our purpose is to evaluate post-operative complications and mortality in patients with diabetes. Using the institutional and clinical databases of three university hospitals from 2009⁻2015, we conducted a matched study of 16,539 diabetes patients, aged >20 years, who underwent major surgery. Using a propensity score matching procedure, 16,539 surgical patients without diabetes who underwent surgery were also selected. Logistic regressions were used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for post-operative complications and in-hospital mortality associated with diabetes. Patients with diabetes had a higher risk of postoperative septicemia (OR 1.33, 95% CI 1.01⁻1.74), necrotizing fasciitis (OR 3.98, 95% CI 1.12⁻14.2), cellulitis (OR 2.10, 95% CI 1.46⁻3.03), acute pyelonephritis (OR 1.86, 95% CI 1.01⁻3.41), infectious arthritis (OR 3.89, 95% CI 1.19⁻12.7), and in-hospital mortality (OR 1.51, 95% CI 1.07⁻2.13) compared to people without diabetes. Previous admission for diabetes (OR 2.33, 95% CI 1.85⁻2.93), HbA1c >8% (OR 1.96, 95% CI 1.64⁻2.33) and fasting glucose >180 mg/dL (OR 1.90, 95% CI 1.68⁻2.16) were predictors for post-operative adverse events. Diabetes patients who underwent surgery had higher risks of infectious complications and in-hospital mortality compared with patients without diabetes who underwent similar major surgeries.
糖尿病对围手术期结局的影响仍未完全明确。我们的目的是评估糖尿病患者术后并发症及死亡率。利用2009年至2015年三家大学医院的机构和临床数据库，我们对16539例年龄大于20岁、接受大手术的糖尿病患者进行了一项匹配研究。采用倾向评分匹配程序，还选取了16539例接受手术的非糖尿病外科患者。使用逻辑回归计算与糖尿病相关的术后并发症及院内死亡率的比值比（OR）及其95%置信区间（CI）。与非糖尿病患者相比，糖尿病患者术后发生败血症（OR 1.33，95%CI 1.01 - 1.74）、坏死性筋膜炎（OR 3.98，95%CI 1.12 - 14.2）、蜂窝织炎（OR 2.10，95%CI 1.46 - 3.03）、急性肾盂肾炎（OR 1.86，95%CI 1.01 - 3.41）、感染性关节炎（OR 3.89，95%CI 1.19 - 12.7）及院内死亡（OR 1.51，95%CI 1.07 - 2.13）的风险更高。既往因糖尿病住院（OR 2.33，95%CI 1.85 - 2.93）、糖化血红蛋白>8%（OR 1.96，95%CI 1.64 - 2.33）及空腹血糖>180 mg/dL（OR 1.90，95%CI 1.68 - 2.16）是术后不良事件的预测因素。与接受类似大手术的非糖尿病患者相比，接受手术的糖尿病患者发生感染性并发症及院内死亡的风险更高。
