1
|
Cătălin Popescu R, Leopa N, Dumitru E, Mitroi A, Tocia C, Dumitru A, Brînzan C, Botea F. Influence of type II diabetes mellitus on postoperative complications following colorectal cancer surgery. Exp Ther Med 2022; 24:611. [PMID: 36160911 PMCID: PMC9469087 DOI: 10.3892/etm.2022.11548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022] Open
Abstract
Diabetes mellitus (DM) promotes colorectal cancer (CRC) carcinogenesis through complex processes and is considered as an independent risk factor for cancer in general and for CRC in particular. Diabetic patients have complications in the postoperative period following CRC surgery. The aim of the present study was to explore the effect of type II DM (T2DM) on postoperative outcomes for CRC compared with non-diabetic patients. The present study analyzed the data from patients admitted to the General Surgery Department, Emergency Hospital of Constanța (Romania) diagnosed with CRC and DM compared with a control group (patients with CRC, without DM, recruited in the same period and frequency matched to cases by number, sex and age) analyzing patient comorbidities and postoperative complications. A total of 61 patients had undergone surgery for CRC and met the inclusion criteria in the present study conducted during September 2020-2021. A total of 30 patients associated T2DM. Diabetic patients have been associated with more comorbidities than non-diabetics; the age-adjusted Charlson comorbidity index score ≥6 was identified in 90% of diabetic patients compared with 45.2% of controls. Grade III Clavien-Dindo classification was observed in 13.3% diabetic patients compared with 3.2% of non-diabetic patients. Additionally, a higher rate of urinary and pulmonary complications (6.7 vs. 3.2% in controls respectively) in patients with diabetes was found. Postoperative hospitalization was prolonged in diabetic patients (P=0.042). Univariate and multivariate analyses revealed that the laparoscopic approach for diabetic patients was found to be associated with <grade III Clavien-Dindo classification (P=0.040) and the absence of surgical site infection (P=0.040). Diabetes predisposes patients to numerous postoperative complications following CRC surgery and postoperative therapeutic conduct must be personalized to prevent possible postoperative complications following CRC.
Collapse
Affiliation(s)
- Răzvan Cătălin Popescu
- Department of General Surgery, Emergency Hospital of Constanța, 900591 Constanța, Romania
| | - Nicoleta Leopa
- Department of General Surgery, Emergency Hospital of Constanța, 900591 Constanța, Romania
| | - Eugen Dumitru
- Faculty of Medicine and Pharmacy Constanta, Ovidius University, 900470 Constanța, Romania
| | - Anca Mitroi
- Department of Pathology, Emergency Hospital of Constanța, 900591 Constanța, Romania
| | - Cristina Tocia
- Faculty of Medicine and Pharmacy Constanta, Ovidius University, 900470 Constanța, Romania
| | - Andrei Dumitru
- Faculty of Medicine and Pharmacy Constanta, Ovidius University, 900470 Constanța, Romania
| | - Costel Brînzan
- Department of Pathology, Emergency Hospital of Constanța, 900591 Constanța, Romania
| | - Florin Botea
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| |
Collapse
|
2
|
Albalawi Z, Laffin M, Gramlich L, Senior P, McAlister FA. Enhanced Recovery After Surgery (ERAS ®) in Individuals with Diabetes: A Systematic Review. World J Surg 2018; 41:1927-1934. [PMID: 28321553 DOI: 10.1007/s00268-017-3982-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prevalence of diabetes in surgical patients is 10-40%. It is well recognized that they have higher rates of complications, and longer stays in hospital compared to patients without diabetes. Enhanced recovery after surgery (ERAS) is an evidence-based multimodal surgical care pathway that improves postoperative complications and length of stay in patients without diabetes. This review evaluates the evidence on whether individuals with diabetes would benefit from ERAS implementation. METHODS MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE searched with no language restrictions applied. Conference proceedings and bibliographies were reviewed. Experts in the field were contacted, and www.clinicaltrials.gov searched for ongoing trials. SELECTION CRITERIA Randomized controlled trials (RCT) looking at individuals with diabetes undergoing surgery randomized to ERAS® or conventional care. Non-randomized controlled trials, controlled before-after studies, interrupted time series, and cohort studies with concurrent controls were also considered. Two authors independently screened studies. RESULTS The electronic search yielded 437 references. After removing duplicates, 376 were screened for eligibility. Conference proceedings and bibliographies identified additional references. Searching www.clinicaltrials.gov yielded 59 references. Contacting experts in the field identified no further studies. Fourteen full articles were assessed and subsequently excluded for the following reasons: used an intervention other than ERAS®, did not include patients with diabetes, or used an uncontrolled observational design. CONCLUSIONS To date, the effects of ERAS® on patients with diabetes have not been rigorously evaluated. This review highlights the lack of evidence in this area and provides guidance on design for future studies.
Collapse
Affiliation(s)
- Zaina Albalawi
- Department of Medicine, University of Alberta, Edmonton, Canada. .,Endocrinology and Metabolism, Alberta Health Services, Edmonton, Canada.
| | - Michael Laffin
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Canada.,Gastroenterology, University of Alberta, Edmonton, Canada
| | - Peter Senior
- Department of Medicine, University of Alberta, Edmonton, Canada.,Endocrinology and Metabolism, University of Alberta, Edmonton, Canada
| | - Finlay A McAlister
- Department of Medicine, University of Alberta, Edmonton, Canada.,General Internal Medicine, University of Alberta, Edmonton, Canada
| |
Collapse
|
3
|
Gil Bona J, Pascual Bellosta A, Ojeda Cabrera J, Ortega Lucea S, Muñoz Rodríguez L, Martínez Ubieto J, Pérez-Navarro G. [Analysis of factors conditioning admission at the critical care unit of surgical patients. Prospective study of 764 patients operated for 1 year at a university and reference hospital]. ACTA ACUST UNITED AC 2014; 62:72-80. [PMID: 25024002 DOI: 10.1016/j.redar.2014.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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 χ(2) 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.
Collapse
Affiliation(s)
- J Gil Bona
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - A Pascual Bellosta
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Ojeda Cabrera
- Departamento de Estadística, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, España
| | - S Ortega Lucea
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - L Muñoz Rodríguez
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Martínez Ubieto
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - G Pérez-Navarro
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| |
Collapse
|
4
|
Montero Ruiz E, Barbero Allende JM, Melgar Molero V, Rebollar Merino Á, García Sánchez M, López Álvarez J. DoSurgeons Have More Difficulties in the Hospital Care of Non-surgery Patients Than With Surgery Patients? Cir Esp 2013; 93:334-8. [PMID: 23473434 DOI: 10.1016/j.ciresp.2012.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 09/07/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. MATERIAL AND METHODS We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). RESULTS Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). CONCLUSIONS Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons.
Collapse
Affiliation(s)
- Eduardo Montero Ruiz
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - José María Barbero Allende
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Virginia Melgar Molero
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Ángela Rebollar Merino
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Marta García Sánchez
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Joaquín López Álvarez
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| |
Collapse
|
5
|
Sabaté A, Gil-Bona J, Pi A, Adroer R, Jaurrieta E. [Perioperative mortality: retrospective cross-sectional study of surgical patients who died between 2004 and 2008 in a tertiary care hospital]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:639-647. [PMID: 22283016 DOI: 10.1016/s0034-9356(10)70300-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. MATERIAL AND METHODS A database was established to record clinical, anesthetic, and surgical variables, grouped as preoperative, intraoperative and postoperative factors, and reflecting comorbidities and postoperative complications. Each patient's cause of death was also recorded. Factors influencing mortality during surgery, at 48 hours, and at 1 week were explored by comparing frequencies to detect correlations. RESULTS From 2004 to 2008, a total of 809 deaths occurred in the 82412 hospitalized surgical patients. Patients who died during surgery or within 48 hours were younger, had a higher ASA physical status classification, had more cardiovascular risk factors, were less likely to have a diagnosis of cancer, and had spent less time in hospital before the operation. Intraoperative complications, particularly bleeding and cardiac events, were more frequent in patients whose condition was more complex and who died during surgery; that pattern was similar but less marked in patients dying within 48 hours. The patients who died within 48 hours had a higher rate of postoperative hemodynamic complications; the patients who died during the week following surgery had higher rates of septic, neurologic, and respiratory complications. CONCLUSIONS Emergency surgery stands out as an important predictor of death during or after surgery; other significant risk factors are postoperative complications.
Collapse
Affiliation(s)
- A Sabaté
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona.
| | | | | | | | | |
Collapse
|
6
|
Gil-Bona J, Sabaté A, Miguelena Bovadilla JM, Adroer R, Koo M, Jaurrieta E. [Charlson index and the surgical risk scale in the analysis of surgical mortality]. Cir Esp 2010; 88:174-9. [PMID: 20701901 DOI: 10.1016/j.ciresp.2010.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/25/2010] [Accepted: 05/30/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is controversy over how to assess surgical mortality risks after different operations. The purpose of this study was to assess the surgical factors that influenced surgical mortality and the ability of the Charlson Index and The Surgical Risk Scale (SRS) to determine low risk patients. MATERIAL AND METHODS All patients who died during the period 2004-2007 were included. The score of both indices (Charlson and SRS) were recorded. A score of «0» for the Charlson Index and «8» for the SRS were chosen as the cut-off point between a low and high probability of death. Three risk groups were established: Low when the Charlson was =0 and SRS was <8; Intermediate when the Charlson was >0 and the SRS <8 or Charlson=0 and SRS ≥8; and high when the Charlson was>0 and the SRS ≥8. The risks factors before, during and after surgery were compared between the groups. RESULTS A total of 72,771 patients were surgically intervened, of which 7011 were urgent. One in every 1455 patients died during surgery and 1 in every 112 died during their hospital stay. Thirteen (2%) patients who died belonged to the low risk group, 199 (30.7%) to the intermediate risk group, and 434 (67.2%) to the high risk group. Heart disease was associated with the high risk group. The urgency of the operation was a determining factor associated with surgical complexity. Re-intervention and sepsis predominated as a cause of death in the low risk group, and in the rest of the groups a cardiac cause was the predominant factor. CONCLUSIONS The combination of the Charlson Index and SRS detected those patients with a low risk of death, thus making it a useful tool to audit surgical results.
Collapse
Affiliation(s)
- Jesús Gil-Bona
- Servicio de Anestesiología Reanimación y Terapéutica del Dolor, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | | | | | | | | | | |
Collapse
|
7
|
Anand N, Chong CA, Chong RY, Nguyen GC. Impact of diabetes on postoperative outcomes following colon cancer surgery. J Gen Intern Med 2010; 25:809-13. [PMID: 20352362 PMCID: PMC2896591 DOI: 10.1007/s11606-010-1336-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 02/02/2010] [Accepted: 03/10/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND Diabetes is the sixth most common cause of death in the US and causes significant postoperative mortality and morbidity. OBJECTIVE To characterize the impact of diabetes among patients undergoing surgery for colorectal cancer. DESIGN This is is a retrospective cohort study. PARTICIPANTS Patients in the Nationwide Inpatient Sample (NIS) who had undergone colorectal cancer surgery between 1998 and 2005. MEASUREMENTS Using multivariate regression, we determined the association of diabetes status with postoperative mortality, postoperative complications, and length of stay. KEY RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Nitasha Anand
- Mount Sinai Hospital Division of Gastroenterology, University of Toronto Faculty of Medicine, 600 University Ave., Ste. 433, Toronto, ON, M5G 1X5, Canada
| | | | | | | |
Collapse
|