Association of Diabetes Mellitus With Postoperative Complications and Mortality After Non-Cardiac Surgery: A Meta-Analysis and Systematic Review

Zhang, Xiaoying; Hou, Aisheng; Cao, Jiangbei; Liu, Yanhong; Lou, Jingsheng; Li, Hao; Ma, Yuanyuan; Song, Yougui; Mi, Weidong; Liu, Jing

doi:10.3389/fendo.2022.841256

Cited by 25 publications

(24 citation statements)

References 144 publications

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“…8 The higher rate may also be related to the patients' comorbidities as diabetes places patients at an increased risk of hematoma postoperatively. 12 Optimizing the management of LVAD-associated infections is of the utmost importance for the tens of thousands of individuals who have received LVADs to date, of whom almost 20% will develop ventricular assist device-specific infections, including infections of the driveline, pocket, pump, and/or cannula, within the first 2 years of implant. 3 Once infected, management is difficult as interactions between the implanted biomaterial and the patient's own immune system lead to progressive decline of cellular immunity, and microbial biofilm develops on the driveline surfaces.…”

Section: Discussionmentioning

confidence: 99%

Plastic Surgery Involvement With Surgical Management of Infected Ventricular Assist Devices Decreased Lifetime Return to Operating Room and 90-Day Infectious Complications

Sweitzer,

Fowler,

Butterfield

et al. 2024

Ann Plast Surg

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Background The use of left ventricular assist devices (LVADs) for patients with end-stage cardiac failure awaiting heart transplantation has become increasingly common. However, ventricular assist device–related infections remain a major problem complicating their long-term use. Retrospective review has previously shown a decrease in lifetime return to operating room (RTOR) with no change in 90-day complications when a muscle or omental flap is used for coverage after washout for infection. We wished to determine if early plastic surgery intervention led to a decreased length of stay for these patients. Methods Patients with LVAD readmitted for LVAD infection at a single institution from 2008 to 2021 were identified using a preexisting database. Patients were followed retrospectively for an average of 3.2 years. Patient demographics, preoperative diagnosis/disease state, type of ventricular assist device inserted, postoperative day of ventricular assist device infection onset, definitive device coverage, timing of coverage procedure after the initial washout for infection, type of flap used for coverage, 90-day complications after definitive coverage, and lifetime return to operating room for infection were reviewed. Comparison analysis with χ 2 and analysis of variance testing was used to analyze outcomes. Results Of 568 patients admitted with an LVAD infection, 104 underwent operative debridement and closure by plastic and reconstructive surgery (PRS) or cardiothoracic surgery (CTS). Fifty-three underwent PRS closure, and 51 underwent CTS closure. There was an increased incidence of diabetes among the PRS group (P < 0.001); otherwise, there was no difference in baseline characteristics. There was increased RTOR over a lifetime with CTS closure compared with PRS (P = 0.03) and increased 90-day risk of infection (P = 0.007). Patients with PRS closure had an increased risk of postoperative hematoma (P = 046). Plastic and reconstructive surgery was typically consulted on hospital day 10. Both PRS and CTS closure patients were discharged on postoperative day 7, on average (P = 0.542). Conclusions Plastic surgery involvement with surgical decision making and closure of infected LVAD devices has a decrease in lifetime RTOR and decreased 90-day complications related to infections. There may be a benefit to earlier PRS consultation for coverage assessment.

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Section: Discussionmentioning

confidence: 99%

Plastic Surgery Involvement With Surgical Management of Infected Ventricular Assist Devices Decreased Lifetime Return to Operating Room and 90-Day Infectious Complications

Sweitzer,

Fowler,

Butterfield

et al. 2024

Ann Plast Surg

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“…In addition, higher postoperative complications have been noted in patients with anemia and perioperative hypoalbuminemia, particularly in low-resource settings [12,13]. A meta-analysis revealed an association between diabetes mellitus with postoperative complications and mortality after non-cardiac surgery [14].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Postoperative Complications in General Surgery Patients

Dharap¹,

Barbaniya²,

Navgale³

2022

Cureus

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BackgroundPostoperative complications, which are undesirable consequences of surgery, need to be minimized to ensure the quality of surgical care. In this study, we aimed to estimate the incidence and identify the risk factors for postoperative complications which may help in planning appropriate preventive measures. MethodologyA prospective observational study was conducted in the general surgery department of a tertiary care hospital in a metropolitan city in India. Patients undergoing elective or emergency surgery were included. Patients transferred postoperatively from other hospitals and those undergoing day-care operations or endoscopic procedures were excluded. Age, gender, body mass index (BMI), comorbidities, surgical risk as per American Society of Anesthesiologists (ASA) grading, scheduling of surgery (emergency, semiemergency, or elective), approach (open or laparoscopic), intraoperative complications, operative blood loss, the extent of surgery (superficial or deep cavity), indication (diagnostic, therapeutic, or palliative), duration of surgery, wound class (clean, clean-contaminated, contaminated, or dirty), and duration of hospital stay in days were recorded. Patients were followed up for 30 days postoperatively for complications (defined as any undesirable, unintended event as a direct result of an operation). Clavien-Dindo classification was used to grade the severity of complications. The chi-square test was used for categorical data, and the t-test was used for numerical data. P-values <0.05 were considered significant. ResultsPostoperative complications were observed in 31.50%; minor complications (Grade I and II) in 19.75% and major complications (Grade III and IV) in 8.0% of patients. Postoperative mortality (Grade V) was 3.75%. Significant risk factors were the presence of comorbidities, higher ASA grade, higher BMI, emergency surgery, open surgery, palliative surgery, deeper cavity surgery, higher intraoperative blood loss, prolonged surgical duration, intraoperative complications, and contaminated surgical wounds. Postoperative complications significantly prolonged the hospital stay. ConclusionsUnderstanding risk factors can guide surgeons to adopt appropriate strategic measures to reduce postoperative complications and improve the quality of surgical care. Three key measures emerging from this study are (1) preoperative patient optimization; (2) diligence during surgery to reduce operative time, blood loss, and intraoperative complications; and (3) implementation of infection control practices.

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“…Beim primären Offenwinkelglaukom können verschiedene Ansätze gewählt werden, um den Augeninnendruck chirurgisch zu senken. Es ist bekannt, dass Patienten mit einem Diabetes mellitus erhöhte Raten an Komplikationen, verlängerte Krankenhausaufenthalte und eine reduzierte Wundheilung aufweisen [33]. Dies gilt primär für allgemeinchirurgische Eingriffe, spielt aber auch bei Operationen am Auge eine Rolle.…”

Section: Chirurgische Verfahrenunclassified

“…For primary open-angle glaucoma, various approaches can be selected in order to surgically reduce the intraocular pressure. It is well-known that patients with diabetes mellitus show increased rates of complications, longer stays in hospital and reduced wound healing [33]. This mainly applies to general surgical procedures but also plays a role in operations on the eye.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Individuelle Behandlung bei Glaukompatienten mit einem Diabetes mellitus

Lübke

2023

Klin Monbl Augenheilkd

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ZusammenfassungDas Glaukom und der Diabetes mellitus sind 2 in Europa und weltweit häufig vorkommende chronische Erkrankungen, die einer intensiven Therapie bedürfen. Pathophysiologisch werden verschiedene Mechanismen diskutiert, die vor allem beim Vorliegen eines Diabetes mellitus die Entstehung eines Glaukoms begünstigen. Die medikamentöse und chirurgische Einstellung des Augeninnendruckes ist bei Patienten mit einem Diabetes mellitus mit einigen Einschränkungen verbunden, so zeigen die filtrierenden Eingriffe geringere Erfolgsraten als bei nicht an Diabetes erkrankten Glaukompatienten. Neben der rein augenheilkundlich-endokrinologischen Therapie sollte ebenfalls die psychologische Belastung durch 2 chronische Erkrankungen bedacht und in den individuellen Therapieplan aufgenommen werden.

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Association of Diabetes Mellitus With Postoperative Complications and Mortality After Non-Cardiac Surgery: A Meta-Analysis and Systematic Review

Cited by 25 publications

References 144 publications

Plastic Surgery Involvement With Surgical Management of Infected Ventricular Assist Devices Decreased Lifetime Return to Operating Room and 90-Day Infectious Complications

Plastic Surgery Involvement With Surgical Management of Infected Ventricular Assist Devices Decreased Lifetime Return to Operating Room and 90-Day Infectious Complications

Incidence and Risk Factors of Postoperative Complications in General Surgery Patients

Individuelle Behandlung bei Glaukompatienten mit einem Diabetes mellitus

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