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.
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