Impact of Diabetes on Postoperative Outcomes Following Colon Cancer Surgery

Mount Sinai Hospital Division of Gastroenterology, University of Toronto Faculty of Medicine, 600 University Ave., Ste. 433, Toronto, ON, M5G 1X5, Canada.
Journal of General Internal Medicine (Impact Factor: 3.42). 03/2010; 25(8):809-13. DOI: 10.1007/s11606-010-1336-7
Source: PubMed


Diabetes is the sixth most common cause of death in the US and causes significant postoperative mortality and morbidity.
To characterize the impact of diabetes among patients undergoing surgery for colorectal cancer.
This is is a retrospective cohort study.
Patients in the Nationwide Inpatient Sample (NIS) who had undergone colorectal cancer surgery between 1998 and 2005.
Using multivariate regression, we determined the association of diabetes status with postoperative mortality, postoperative complications, and length of stay.
An estimated 218,534 patients had undergone surgery for colorectal cancer. We categorized subjects by the presence of diabetes, the prevalence of which was 15%. Crude postoperative in-hospital mortality was lower among diabetics compared to non-diabetics (2.5% vs. 3.2%, P < 0.0001). Adjusted mortality was 23% lower in those with diabetes compared to non-diabetics (aOR 0.77; 95% CI: 0.71-0.84). Diabetics also had lower adjusted post-operative complications compared to non-diabetics (aOR 0.82; 95% CI: 0.79-0.84). In uninsured individuals and patients <50 years of age, there was no protective association between diabetes and either in-hospital mortality or postoperative complications.
In patients undergoing colorectal cancer surgery, those with diabetes had a 23% lower mortality and fewer postoperative complications compared to non-diabetics. The mechanisms underlying this unexpected observation warrant further investigation.

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    • "Chen et al. concluded that T2DM increases the risk of CRC recurrence after surgical resection. However, Anand et al. reported conflicting results for T2DM and CRC [28]. They included 218,534 American CRC surgical patients from the Nationwide Inpatient Sample and observed a T2DM prevalence of 15%. "
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    ABSTRACT: Obesity has become a major issue for healthcare providers as its prevalence continues to increase throughout the world. The literature suggests that increased body mass index (BMI) is associated with the development of certain cancers such as colorectal cancer (CRC). Consequently, CRC surgeons are now encountering an increasing number of obese patients which may influence the technical aspects and outcomes of surgical treatment. For instance, obese patients present with greater comorbidities preoperatively, which adds increasing complexity and risks to surgical management. Recent literature also suggests that obesity may increase operating time and conversion rates to open colorectal surgery. Postoperative outcomes may also be influenced by obesity; however, this currently remains controversial. There is evidence that survival rates after CRC surgery are not influenced by obesity. In summary, obesity presents challenges to CRC surgeons, and further research will be needed to show how this important characteristic influences the outcomes for CRC patients.
    Gastroenterology Research and Practice 12/2012; 2012(6917):768247. DOI:10.1155/2012/768247 · 1.75 Impact Factor
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    Journal of the Korean Society of Coloproctology 12/2010; 26(6):376. DOI:10.3393/jksc.2010.26.6.376
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    ABSTRACT: Objective Assess what factors determine the income of surgical patients in critical care unit after surgery. Material and methods It included a survey of the 10% of all patients operated by the services of General Surgery, Thoracic Surgery, Maxillofacial Surgery, Vascular Surgery, Urology and Otolaryngology during 2012. We performed a prospective, observational study. Pre-, intra-, and post-operative variables were analyzed. Comparisons were made between patients operated under elective and emergency surgery, and between patients admitted in critical care and admitted directly in the ward, using χ2 of Pearson correlation with a confidence interval of 95%. Results Seven hundred and sixty-four patients were included into the study, 304 were admitted in critical care after surgery and 460 were admitted in the ward. The medical history showed a statistically significant association with intensive care unit admission, well as the fact of being labeled with a high risk for the risk scales. Complexity and duration of the surgery showed a statistically significant association with intensive care unit admission, as well as the fact of present intra-operative complications. Emergency surgery was not significantly associated with intensive care unit admission of surgical patients, although these patients had significantly higher numbers of intra- and post-operative complications, and more exitus than those undergoing elective surgery. Conclusions A greater incidence of intensive care unit admission of patients undergoing emergency surgery should significantly reduce morbimortality rate. The existence of specific protocols for intensive care unit admission for urgent surgery, and greater availability of beds could be useful in this regard.
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