The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery

In hospital outcomes of autologous and implant-based breast reconstruction in patients with diabetes mellitus: A population-based study of 2015-2020 national inpatient sample

BACKGROUND

Breast reconstruction encompasses autologous (ABR) and implant-based breast reconstruction (IBR) each with its own sets of potential complications. Diabetes mellitus (DM) is associated with breast reconstruction complications, although most of the studies did not differentiate between the reconstruction procedures. This study conducted a population-based study examining impact of DM on inhospital outcomes in ABR and IBR.

METHODS

Patients underwent ABR or IBR were identified in National Inpatient Sample from Q4 2015 to 2020. A 1:2 propensity score matching was used to address differences in demographics, hospital characteristics, primary payer status, comorbidities, and reconstruction staging between DM and non-DM patients. In hospital outcomes were assessed separately in ABR and IBR.

RESULTS

There were 997 (7.68%) DM and 11,987 (92.32%) non-DM patients in ABR. Meanwhile, 1325 (7.38%) DM and 16,638 (92.62%) non-DM patients underwent IBR. DM cohorts in ABR and IBR were matched to 1930 and 2558 non-DM patients, respectively. After matching, DM patients in both ABR and IBR had higher risks of renal complications (ABR, 3.73% vs. 1.76%, p < 0.01; IBR, 1.83% vs. 0.78%, p = 0.01) and longer length of stay (ABR, p = 0.01; IBR, p = 0.04). In ABR, DM patients had higher respiratory complications (2.82% vs. 1.19%, p < 0.01), excessive scarring (2.72% vs. 1.55%, p = 0.03), and infection (2.42% vs. 1.14%, p = 0.01), while in IBR, DM patients had higher hemorrhage/hematoma (5.40% vs. 3.40%, p < 0.01) and transfer out (1.52% vs. 0.78%, p = 0.04).

CONCLUSION

DM was associated with distinct sets of inhospital complications in ABR and IBR, which can be valuable for preoperative risk stratification and informing clinical decision-making for DM patients.

The Impact of Diabetes on Morbidity and Mortality Following Thyroidectomy

OBJECTIVES

To explore the association between diabetes and outcomes in thyroidectomy patients.

METHODS

This retrospective cohort analysis used the 2015-2017 American College of Surgeons National Surgery Quality Improvement Program database. Current Procedural Terminology (CPT) codes were used to identify thyroidectomy cases (60210, 60212, 60220, 60225, 60240, 60252, 60254, 60260, 60270, and 60271). Demographics, comorbidities, and complication incidences were compared between diabetic and nondiabetic patients using Pearson's chi-square test/Fisher's exact test as appropriate. The independent effect of diabetes on outcomes was analyzed using binary logistic regression.

RESULTS

A total of 47,776 (95.4%) nondiabetic and 2307 (4.6%) diabetic patients undergoing thyroidectomy were identified from 2015 to 2017. Chi-square analysis demonstrated that diabetic patients had higher incidences of obesity (55.2% vs. 33.2%; p < 0.001), dyspnea (12.7% vs. 4.8%; p < 0.001), poor functional status (1.9% vs. 0.4%; p < 0.001), ventilator dependence (0.6% vs. 0.1%; p < 0.001), chronic obstructive pulmonary disease (COPD; 6.8% vs. 2.2%; p < 0.001), congestive heart failure (1.1% vs. 0.3%; p < 0.001), acute renal failure (0.3% vs. 0.0%; p < 0.001), hypertension (79.2% vs. 32.4%; p < 0.001), dialysis (2.0% vs. 0.4%; p < 0.001), open wound (1.1% vs. 0.1%; p < 0.001), steroid use (5.3% vs. 2.3%; p < 0.001), bleeding disorders (3.6% vs. 0.9%; p < 0.001), preoperative blood transfusions (0.2% vs. 0.0%; p = 0.001), and systemic sepsis (1.0% vs. 0.3%; p < 0.001). Demographic characteristics were significantly different between the cohorts including gender (p < 0.001), age (p < 0.001), race (p < 0.001), and Hispanic ethnicity (p = 0.033). After adjusting for these factors, logistic regression analyses showed that diabetes was associated with acute renal failure (OR: 5.836; 95% CI: 1.060-32.134; p = 0.043), wound disruption (OR: 6.194; 95% CI: 1.752-21.900; p = 0.005), prolonged length of stay (OR: 1.430; 95% CI: 1.261-1.622; p < 0.001), unplanned readmission (OR: 1.380; 95% CI: 1.096-1.737; p = 0.006), superficial incisional surgical site infections (OR: 0.240; 95% CI: 0.058-0.995; p = 0.049), urinary tract infection occurrences (OR: 2.173; 95% CI: 1.186-3.980; p = 0.012), organ space surgical site infection occurrences (OR: 3.322; 95% CI: 1.016-10.864; p = 0.047), pneumonia occurrences (OR: 2.091; 95% CI: 1.125-3.884; p = 0.020), any medical complication (OR: 1.697; 95% CI: 1.246-2.313; p = 0.001), and any complication (OR: 1.495; 95% CI: 1.136-1.968; p = 0.004).

CONCLUSION

Diabetes mellitus is a significant factor associated with increased odds of complications following thyroidectomy.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:3628-3632, 2023.

Risk Factors for Post-Operative Pulmonary Infection in Patients With Brain Tumors: A Systematic Review and Meta-Analysis

Background: This study aims to analyze the risk factors for post-operative pulmonary infection in patients with brain tumors by meta-analysis to provide a reference for its prevention. Methods: PubMed, Embase, Web of Science, Cochrane Library, Ovid, and four Chinese databases (CNKI, SinoMed, VIP, and Wanfang databases) were searched for studies covering risk factors of pulmonary infection in patients with brain tumors, limited to the duration from the dates of inception of the respective databases to December 31, 2022. The Newcastle-Ottawa scale was used to assess the evidence. A meta-analysis of the factors affecting the incidence of pulmonary infection was performed using Revman 5.4 software. Results: Twelve studies were selected, covering 35,615 patients with brain tumors, among whom pulmonary infection occurred in 1,635 cases with an accumulated incidence of 4.6%, including 38 related risk factors. Meta-analysis results indicated: history of chronic pulmonary disease (odds ratio [OR], 5.74; 95% confidence interval [CI], 1.34-24.51; p = 0.02], diabetes mellitus (OR, 1.58; 95% CI, 1.29-1.95; p < 0.0001), history of cardiovascular disease (OR, 3.97; 95% CI, 2.18-7.24; p < 0.00001), age ≥60 years (OR, 1.55; 95% CI, 1.12-2.15; p = 0.009)], operation time ≥3 hours (OR, 1.03; 95% CI, 1.00-1.05; p = 0.03], Glasgow Coma Scale (GCS) score <13 (OR, 3.5; 95% CI, 1.90-6.46; p < 0.0001), and the American Society of Anesthesiologists classification (ASA) ≥3 (OR, 2.03; 95% CI, 1.68-2.46; p < 0.00001) as independent risk factors. Conclusions: History of chronic pulmonary disease, diabetes mellitus, history of cardiovascular disease, age ≥60 years, operation time ≥3 hours, GCS score <13, and the ASA grade ≥3 are independent risk factors for post-operative pulmonary infection in patients with brain tumors, which nursing staff should be aware of.

Postoperative short-term mortality between insulin-treated and non-insulin-treated patients with diabetes after non-cardiac surgery: a systematic review and meta-analysis

Background

Diabetes mellitus is an independent risk factor for postoperative complications. It has been reported that insulin-treated diabetes is associated with increased postoperative mortality compared to non-insulin-treated diabetes after cardiac surgery; however, it is unclear whether this finding is applicable to non-cardiac surgery.

Objective

We aimed to assess the effects of insulin-treated and non-insulin-treated diabetes on short-term mortality after non-cardiac surgery.

Methods

Our study was a systematic review and meta-analysis of observational studies. PubMed, CENTRAL, EMBASE, and ISI Web of Science databases were searched from inception to February 22, 2021. Cohort or case-control studies that provided information on postoperative short-term mortality in insulin-treated diabetic and non-insulin-treated diabetic patients were included. We pooled the data with a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to rate the quality of evidence.

Results

Twenty-two cohort studies involving 208,214 participants were included. Our study suggested that insulin-treated diabetic patients was associated with a higher risk of 30-day mortality than non-insulin-treated diabetic patients [19 studies with 197,704 patients, risk ratio (RR) 1.305; 95% confidence interval (CI), 1.127 to 1.511; p < 0.001]. The studies were rated as very low quality. The new pooled result only slightly changed after seven simulated missing studies were added using the trim-and-fill method (RR, 1.260; 95% CI, 1.076-1.476; p = 0.004). Our results also showed no significant difference between insulin-treated diabetes and non-insulin-treated diabetes regarding in-hospital mortality (two studies with 9,032 patients, RR, 0.970; 95% CI, 0.584-1.611; p = 0.905).

Conclusion

Very-low-quality evidence suggests that insulin-treated diabetes was associated with increased 30-day mortality after non-cardiac surgery. However, this finding is non-definitive because of the influence of confounding factors.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021246752, identifier: CRD42021246752.

Nomogram prediction model of postoperative pneumonia in patients with lung cancer: A retrospective cohort study

Background

The prediction model of postoperative pneumonia (POP) after lung cancer surgery is still scarce.

Methods

Retrospective analysis of patients with lung cancer who underwent surgery at The Fourth Hospital of Hebei Medical University from September 2019 to March 2020 was performed. All patients were randomly divided into two groups, training cohort and validation cohort at the ratio of 7:3. The nomogram was formulated based on the results of multivariable logistic regression analysis and clinically important factors associated with POP. Concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow goodness-of-fit test and decision curve analysis (DCA) were used to evaluate the predictive performance of the nomogram.

Results

A total of 1252 patients with lung cancer was enrolled, including 877 cases in the training cohort and 375 cases in the validation cohort. POP was found in 201 of 877 patients (22.9%) and 89 of 375 patients (23.7%) in the training and validation cohorts, respectively. The model consisted of six variables, including smoking, diabetes mellitus, history of preoperative chemotherapy, thoracotomy, ASA grade and surgery time. The C-index from AUC was 0.717 (95%CI:0.677-0.758) in the training cohort and 0.726 (95%CI:0.661-0.790) in the validation cohort. The calibration curves showed the model had good agreement. The result of DCA showed that the model had good clinical benefits.

Conclusion

This proposed nomogram could predict the risk of POP in patients with lung cancer surgery in advance, which can help clinician make reasonable preventive and treatment measures.

What are Risk Factors of Postoperative Pneumonia in Geriatric Individuals after Hip Fracture Surgery: A Systematic Review and Meta-Analysis

Postoperative pneumonia (POP) is a common postoperative complication. Negative consequences associated with POP included prolonged hospital length of stay, more frequent intensive care unit (ICU) stays, and a higher rate of sepsis, readmission, and mortality. This meta-analysis aimed to assess the incidence and risk factors associated with POP after hip fracture surgery in elderly patients. PubMed, Web of Science, and Cochrane Library were searched (up to March 31, 2022). All studies on the risk factors for POP after hip fracture surgery in elderly patients, published in English, were reviewed. The qualities of the included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled, and a meta-analysis was performed. Ten studies, including 12,084 geriatric patients undergoing hip fracture surgery, were included. Of these 12,084 patients, POP occurred in 809 patients. The results indicated that age (mean difference [MD] = 4.95, 95% confidence interval [CI]: 3.22-6.69), male (odds ratio [OR] = 1.41, 95% CI: 1.02-1.93), the American Society of Anaesthesiologists classification ≥3 (OR = 3.48, 95% CI: 1.87-6.47), dependent functional status (OR = 5.23, 95% CI: 2.18-12.54, P = 0.0002), smoking (OR = 1.33, 95% CI: 1.07-1.65), chronic obstructive pulmonary disease (OR = 3.76, 95% CI: 2.07-6.81), diabetes mellitus (OR = 1.19, 95% CI: 1.01-1.40), coronary heart disease (OR = 1.74, 95% CI: 1.23-2.46), arrhythmia (OR = 1.47, 95% CI: 1.01-2.14), cerebrovascular disease (OR = 1.88, 95% CI: 1.56-2.27), dementia (OR = 2.36, 95% CI: 1.04-5.36), chronic renal failure (OR = 1.85, 95% CI: 1.29-2.67), hip arthroplasty (OR = 1.30, 95% CI: 1.08-1.56), delayed surgery (OR = 6.40, 95% CI: 3.00-13.68), preoperative creatinine (MD = 5.32, 95% CI: 0.55-10.08), and preoperative serum albumin (MD = -3.01, 95% CI: -4.21 - -1.80) were risk factors for POP. Related prophylactic measures should be provided in geriatric patients with the above-mentioned risk factors to prevent POP after hip fracture surgery.

Disease Staging: Prevalence of Cardiorespiratory Complications in Type 2 Diabetes Mellitus

Introduction: The incidence of cardiorespiratory complications in diabetic patients is a major concern for healthcare organizations and providers in Portugal. The objectives of this study were (1) to study the prevalence of cardiorespiratory complications during hospitalization in the diabetic population and (2) to identify their associated factors.Methods: This is a cross-sectional study and included 7,347 diabetic patients admitted to all specialty services enrolled between January 1, 2018 and December 31, 2018 in 32 public hospitals in Portugal. Hospital discharge summary data and both Disease-Related Diagnosis Groups and Disease Staging were used. Descriptive statistical analysis was used where the distribution and rates of cardiorespiratory complications were calculated. Logistic regression using the risk adjustment model was used to calculate the associated risk factors for cardiorespiratory complications.Results: The total rate of cardiorespiratory complications was 18.2% cardiorespiratory complications; in women it was 21.5% and in men 15.6%. The comorbidity of congestive heart failure (98.0%) was significantly higher (P<0.001) among patients undergoing medical treatment, and the comorbidities bacterial pneumonia and coronary artery disease without prior coronary revascularization were significantly higher (63.9%, 45.1%, and 33.4%, P<0.001).Discussion: The use of different therapies to control glucose levels and the absence of antibiotic prophylaxis during medical treatment may account for these data.Conclusions: Cardiorespiratory complications were higher in women than in men and in those who received medical treatment. Comorbidities such as congestive heart failure, such as bacterial pneumonia and coronary artery disease without prior coronary revascularization were identified as risk factors.

Incidence of Postoperative Pneumonia and Oral Microbiome for Patients with Cancer Operation

Postoperative pneumonia is a serious problem for patients and medical staff. In Japan, many hospitals introduced perioperative oral care management for the efficient use of medical resources. However, a high percentage of postoperative pneumonia still developed. Therefore, there is a need to identify the specific respiratory pathogens to predict the incidence of pneumonia The purpose of this study was to find out the candidate of bacterial species for the postoperative pneumonia. This study applied case-control study design for the patients who had a cancer operation with or without postoperative pneumonia. A total of 10 patients undergoing a cancer operation under general anesthesia participated in this study. The day before a cancer operation, preoperative oral care management was applied. Using the next generation sequence, oral microbiome of these patients was analyzed at the time of their first visit, the day before and after a cancer operation. Porphyromonas gingivalis and Fusobacterium nucleatum group can be a high risk at first visit. Atopobium parvulum and Enterococcus faecalis before a cancer operation can be a high risk. Poor oral hygiene increased the risk of incidence of postoperative pneumonia. Increased periodontal pathogens can be a high risk of the incidence of postoperative pneumonia. In addition, increased intestinal bacteria after oral care management can also be a high risk for the incidence of postoperative pneumonia.

Effects of periodontitis on postoperative pneumonia in patients with lung and esophageal cancer

Background

Few studies have been conducted on the relationship between chronic periodontitis and postoperative pneumonia (POP) in patients with lung and esophageal cancer. Furthermore, it remains controversial as to whether improving the periodontal condition of patients with lung and esophageal cancer before surgery reduces the incidence of POP. This retrospective study was conducted to assess the effects of periodontal therapy in patients with lung and esophageal cancer to prevent POP.

Methods

A total of 265 patients with lung or esophageal cancer complicated with chronic periodontitis who underwent open thoracotomy between July 2015 and June 2019 were selected and given the choice of being in the experimental or control group. A total of 141 participants in the experimental group received periodontal therapy, and 124 participants in the control group did not receive periodontal therapy. All clinical data of participants in both groups were retrospectively studied to determine the incidence of POP on the 30th day after discharge from hospital.

Results

Eight patients in the experimental and six in the control group, respectively, were excluded from the study. It was found that four of the 133 patients suffered from POP in the experimental group (incidence: 3.01%). A total of 18 of 118 patients in the control group had a pulmonary infection (incidence: 15.25%). POP incidence in the experimental group was significantly lower than that in the control group, and in the level analysis of different types of periodontitis, surgical methods, and diseases (p < 0.05).

Conclusions

Periodontal treatment is associated with a lower incidence of POP following lung and esophageal cancer surgery. Improving the periodontal condition of patients helps prevent POP. The presence of periodontitis is an important predisposing factor for POP in patients after open thoracotomy. Periodontal examination and therapy are recommended before the surgical treatment of lung or esophageal cancer.

The Performance of CURB-65 and PSI for Predicting In-Hospital Mortality of Community-Acquired Pneumonia in Patients with Type 2 Diabetes Compared with the Non-Diabetic Population

OBJECTIVE

To compare the performance of CURB-65 and Pneumonia Severity Index (PSI) for predicting in-hospital mortality of community-acquired pneumonia (CAP) between patients with and without type 2 diabetes (T2DM).

METHODS

A retrospective study was conducted on 2365 CAP patients in The First Hospital of Qinhuangdao, China. The primary outcome was in-hospital mortality. The area under curves (AUCs) was used to evaluate the abilities of CRB-65, CURB-65, and PSI class for predicting in-hospital mortality in patients with CAP.

RESULTS

Among CAP patients, 127 patients (5.4%) died, 80 patients were without diabetes, and 47 patients had T2DM. In-hospital mortality increased with the risk stratification defined as CURB-65 and PSI class in both non-diabetes and T2DM patients (P<0.05). The AUCs for predicting in-hospital mortality were 0.728～0.798 in patients without T2DM (CRB-65: 0.728, CURB-65: 0.757 and PSI class: 0.798) and 0.641～0.716 in patients with T2DM (CRB-65: 0.641, CURB-65: 0.677 and PSI class: 0.716)(P<0.001). The AUC of the PSI class was lower in patients with T2DM than in patients without T2DM (P<0.05).

CONCLUSION

CURB-65 and PSI class are correlated with in-hospital mortality of CAP in patients with and without T2DM. Compared with non-diabetes patients, the predictive performance of CURB-65 and PSI class decreased in patients with T2DM. A prediction model for evaluating the CAP severity in the T2DM population should be developed by future studies.

The Effects of Diabetes and Hypertension on the Severity of COVID-19 - Yichang, Hubei Province, 2020

What is already known on this topic?

COVID-19 has become a serious public health issue. A higher proportion of severe patients were senior patients with underlying diseases such as diabetes and hypertension and had a lack of statistical evidence so far.

What is added by this report?

When severe illness was compared with non-severe illness, senior patients were at a greater risk (4.71) than young and middle-aged patients, as well as the odds ratio was about 2.99 patients with diabetes compared to patients without diabetes and hypertension. COVID-19-infectious senior patients with diabetes were inclined to suffer severe illness.

What are the implications for public health practice?

Much more attention should be provided for the elderly and individuals with diabetes, for which a community-based education and surveillance program could be considered.

The Implication of Oxidative Stress and AMPK-Nrf2 Antioxidative Signaling in Pneumonia Pathogenesis

It is widely recognized that chemical, physical, and biological factors can singly or synergistically evoke the excessive production of oxidative stress in pulmonary tissue that followed by pulmonary lesions and pneumonia. In addition, metabolic and endocrine disorder-induced diseases such as diabetes and obesity often expressed higher susceptibility to pulmonary infections, and presented severe symptoms which increasing the mortality rate. Therefore, the connection between the lesion of the lungs and the metabolic/endocrine disorders is an interesting and essential issue to be addressed. Studies have noticed a similar pathological feature in both infectious pneumonia and metabolic disease-intercurrent pulmonary lesions, that is, from the view of molecular pathology, the accumulation of excessive reactive oxygen species (ROS) in pulmonary tissue accompanying with activated pro-inflammatory signals. Meanwhile, Adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) and nuclear factor erythroid-2-related factor 2 (Nrf2) signaling plays important role in metabolic/endocrine homeostasis and infection response, and it's closely associated with the anti-oxidative capacity of the body. For this reason, this review will start from the summary upon the implication of ROS accumulation, and to discuss how AMPK-Nrf2 signaling contributes to maintaining the metabolic/endocrine homeostasis and attenuates the susceptibility of pulmonary infections.