Enhanced Recovery after Surgery (ERAS®) Outcomes in Patients with Prior Diagnosis of Diabetes

Abstract

Objective. To determine whether a prior diagnosis of diabetes mellitus (DM) is associated with longer postoperative length of stay (LOS) and higher complication rates among patients who underwent colorectal surgery under an Enhanced Recovery After Surgery (ERAS) protocol in a single hospital setting.Methodology. In a cross-sectional study, we grouped 157 consecutive patients who underwent elective colorectal surgery under ERAS protocol according to preoperative DM status. Patient data was abstracted from the ERAS Interactive Audit Database from January 2016 to December 2017. We compared LOS between groups. Secondary outcomes were postoperative complications, reoperations, pneumonia and wound infection. Categorical and continuous variables were analyzed with Fisher's exact test and student's t-test, respectively, using Stata/SE version 13 with a significance level of p=0.05.Results. One hundred thirteen subjects did not have diabetes (no T2DM) while 44 patients had type 2 diabetes mellitus (T2DM). Mean postoperative length of hospital stay was 6.4±5.1 days for the no T2DM group versus 5.8±3.8 in the T2DM group (p=0.476). Complications, reoperation rate, pneumonia and wound infection did not differ between groups. Among subjects in the T2DM group, LOS did not differ between patients with preoperative HbA1c ≤7.0% and those with HbA1c >7.0% (5.7±3.7 versus 6.1±4.2 days, p=0.748). Conclusion.Among patients who underwent colorectal surgery under ERAS protocol, a prior diagnosis of diabetes was not associated with longer LOS or more complications. A preoperative HbA1c of <7% did not affect length of stay in ERAS among patients with T2DM.

The impact of preoperative glycated hemoglobin (HbA1c) on postoperative complications after elective major abdominal surgery: a meta-analysis

“…The postoperative complications extracted from the primary studies were initially graded according to CD classification, and then grouped for intent of either the primary outcome (major postoperative complications) or secondary outcome (overall postoperative complications) analyses. Examples of postoperative complications from the primary studies that fulfilled the definition of our primary outcome of 'Major Postoperative Complications' include "reoperation" [17], "anastomotic leak" [18]- [23], "30-day mortality" [23] and "major complications fulfilling CD3-5" [24]- [26]. Secondary outcomes were categorised into overall complications, anastomotic leak, postoperative ileus, overall infections, wound infection, pneumonia, sepsis, cardiopulmonary complications, and renal failure [13],…”

“…The HbA1c cut-off used to dichotomise case and control groups were variable. The most common cut-off points were HbA1c 6.5% [19], [24], [26], [31], [32] and 7.0% [17], [20], [23], [34] with five and four studies respectively. Most studies used a HbA1c measurement within at least 3 months before surgery, except for one study which used HbA1c…”

“…measurements within 6 months before surgery [35]. A few studies did not state the timeframe window between HbA1c measurement and surgery [17], [20]- [23], [32], [34]. A total of 25036 patients were included in the quantitative analysis.…”

“…The most studied outcome measures were infection [17], [18], [20], [22], [23], [31], [34] and anastomotic leak [18]- [23], [34]. Some studies investigated the individual effects of different types of infection such as pneumonia, urinary tract infection (UTI), wound infection, and sepsis [17], [18], [23], [31],…”

“…Among the 12 studies reporting overall complications [17], [18], [32], [33], [19]- [24], [26], [31], Wang et al reported anastomotic leak and postoperative infections data separately [22]. We included this study in our primary analysis and conducted a sensitivity analysis with the study excluded to ensure no double-counting of patients with complications, as we were unable to obtain the original patientlevel data from the authors.…”