Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Surg Endosc. 2024 Aug;38(8):4207-4214. doi: 10.1007/s00464-024-10936-2. Epub 2024 Jun 7.
Diabetes is considered a general surgical risk factor, but with few data from enhanced recovery (ERAS) otherwise known to improve outcome. Therefore, this study aimed to investigate postoperative outcomes of patients with diabetes who underwent video-assisted thoracoscopic surgery (VATS) lobectomy in an established ERAS setting.
We retrospectively analysed outcome data (hospital stay (LOS), readmissions, and mortality) from a prospective database with consecutive unselected ERAS VATS lobectomies from 2012 to 2022. Complete follow-up was secured by the registration system in East Denmark.
We included 3164 patients of which 323 had diabetes, including 186 treated with insulin and antidiabetic medicine, 35 with insulin only and 102 with antidiabetic medicine only. The median LOS was 3 days, stable over the study period. There were no differences in terms of LOS, postoperative complications, readmissions or 30 days alive and out of hospital. Patients with diabetes had significantly higher 30- and 90-day mortality rates compared to those without diabetes (p < .001), but also had higher preoperative comorbidity. Preoperative HbA1c levels did not correlate with postoperative outcomes.
In an ERAS setting, diabetes may not increase the risk for prolonged LOS, complications, and readmissions after VATS lobectomy, however with higher 30- and 90-day mortality probably related to more preoperative comorbidities.
糖尿病被认为是一般外科手术的危险因素，但缺乏强化康复（ERAS）的数据，而 ERAS 已知可以改善预后。因此，本研究旨在调查在既定 ERAS 环境下接受电视辅助胸腔镜手术（VATS）肺叶切除术的糖尿病患者的术后结果。
我们回顾性分析了 2012 年至 2022 年连续非选择性 ERAS VATS 肺叶切除术前瞻性数据库中的结果数据（住院时间（LOS）、再入院和死亡率）。通过丹麦东部的登记系统确保了完整的随访。
我们纳入了 3164 名患者，其中 323 名患有糖尿病，包括 186 名接受胰岛素和降糖药物治疗，35 名仅接受胰岛素治疗，102 名仅接受降糖药物治疗。中位 LOS 为 3 天，在研究期间保持稳定。在 LOS、术后并发症、再入院或 30 天存活和出院方面，两组之间没有差异。与无糖尿病患者相比，糖尿病患者的 30 天和 90 天死亡率显著更高（p < 0.001），但术前合并症也更高。术前 HbA1c 水平与术后结果无关。
在 ERAS 环境中，糖尿病可能不会增加 VATS 肺叶切除术后 LOS 延长、并发症和再入院的风险，但 30 天和 90 天死亡率更高，可能与术前合并症更多有关。
