Increased 30‐day mortality in patients with diabetes undergoing surgery for colorectal cancer

Fransgaard, Tina; Thygesen, Lau Caspar; Gögenür, Ismail

doi:10.1111/codi.13158

Cited by 16 publications

(16 citation statements)

References 25 publications

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“…In addition this study does not corroborate with Yeh et al, [14], which found that diabetes independently increases the perioperative risks to patients. To further conflict with these results, Fransgaard et al, [15] found no increased perioperative morbidity, but an increase of 17% in 30-day mortality in patients with diabetes. By including more variables into our multivariate analysis, we have been thorough in removing possible confounding factors in addition to ensuring that all surgeries were conducted with a specialist colorectal surgeon.…”

Section: Discussionmentioning

confidence: 96%

“…Yeh et al, [14] used a nationwide database from Taiwan comparing diabetic to non-diabetic patients and found that patients with diabetes were at higher risk of perioperative mortality, as well as at higher risk of acute renal failure and acute myocardial infarction. Fransgaard et al, [15] found an increased 30-day mortality for patients with diabetes but no increase in post-operative complications. Anand et al, [16] using the United States Nationwide Inpatient sample database, concluded that patients with diabetes had a 23% lower mortality and fewer perioperative complications compared to patients without diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…It is unclear why these three studies vary so much in their results and conclusions. Anand et al, [16] and Fransgaard et al, [15] only examined patients undergoing colorectal resection, while Yeh et al, (13) examined all non-cardiac surgery patients. It may be that Anand et al, (14) had a significant number of patients that were classified as diabetic patients, but in fact had sub-clinical diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…However, this may have selected out a cohort at higher risk who would have other significant co-morbidities. Fransgaard et al, [15] based their diagnosis of diabetes on a combination of a national patient register and a national prescription registry. No differences were found between the different diabetic medication groups (metformin, oral diabetic medication, insulin and diet control) in mortality or morbidity.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Diabetes on the Perioperative Outcomes of Colorectal Cancer Surgery Patients

et al. 2016

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There are approximately 1.3 million patients in Australia with diabetes. Conflicting reports exist in the literature as to the effect of diabetes on the outcomes of colorectal cancer patients. We hypothesized that patients with diabetes would have poorer perioperative outcomes, and that diabetes was an independent risk factor for both 30-day mortality and perioperative morbidity. The aim of this study was to assess the impact of diabetes on perioperative colorectal cancer surgery outcomes, as compared to a diabetes-free reference population, and to examine factors affecting perioperative risk. We conducted an analysis of a prospectively collected, clinician-led colorectal cancer database of patients from 2010–2015. Patients with diabetes were compared to patients without diabetes on a range of perioperative outcomes. Pearson χ-squared tests, Wilcoxon rank sum tests and t-tests were employed for univariate analyses. Confounding factors were controlled for by separate logistic and linear regression analyses. The Huber-White Sandwich Estimator was used to calculate robust standard errors. A total of 1725 patients were analysed over 1745 treatment episodes in the study period with 267 patients (268 episodes) with diabetes studied. Diabetes contributed to medical, surgical complications, and increased length of inpatient stay in univariate analyses. Multivariable analysis adjusted for variables independently associated with each outcome revealed that diabetes was an independent contributor to an increased risk of surgical complications, with no significant effect on medical complications, return to the operating room, 30-day mortality, or readmission within 30 days. In this study, where overall baseline morbidity and mortality levels are low, the effect of diabetes alone on perioperative surgical outcomes appears to be overstated with control of associated perioperative risk factors such as cardiac, renal and respiratory factors being more important.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Diabetes on the Perioperative Outcomes of Colorectal Cancer Surgery Patients

et al. 2016

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“…A meta-analysis has reported the effect of DM on CRC prognosis[5], but since 2013, a series of large-scale long-term cohort studies had comprehensively reported the outcome effect estimates on the relationship between DM and CRC prognosis, and their results were still consistent[6–20]. For example, in overall survival (OS) of CRC, several studies found that DM showed a significant decreased risk in OS[6, 7, 12–14, 17], and others found no link[8–11, 15, 16, 18–20]. The data from these studies has also allowed us to evaluate the relationship between DM and CRC prognosis more accurately.…”

Section: Introductionmentioning

confidence: 99%

The relationship between diabetes and colorectal cancer prognosis: A meta-analysis based on the cohort studies

Zhu

et al. 2017

PLoS ONE

101

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IntroductionThough a meta-analysis reported the effect of diabetes on colorectal prognosis in 2013, a series of large-scale long-term cohort studies has comprehensively reported the outcome effect estimates on the relationship between diabetes and colorectal prognosis, and their results were still consistent.MethodsWe carried out an extensive search strategy in multiple databases and conducted a meta-analysis on the effect of diabetes on colorectal prognosis, based on the included 36 cohort studies, which contained 2,299,012 subjects. In order to collect more data, besides conventional methods, we used the professional software to extract survival data from the Kaplan-Meier curves, and analyzed both the 5-year survival rate and survival risk in overall survival, cancer-specific survival, cardiovascular disease—specific survival, disease-free survival, and recurrence-free survival, to comprehensively reflect the effect of diabetes on colorectal prognosis.ResultsThe results found that compared to patients without diabetes, patients with diabetes will have a 5-year shorter survival in colorectal, colon and rectal cancer, with a 18%, 19% and 16% decreased in overall survival respectively. We also found similar results in cancer-specific survival, cardiovascular disease—specific survival, disease-free survival, and recurrence-free survival, but not all these results were significant. We performed the subgroup analysis and sensitivity analysis to find the source of heterogeneity. Their results were similar to the overall results.ConclusionsOur meta-analysis suggested that diabetes had a negative effect on colorectal cancer in overall survival. More studies are still needed to confirm the relationship between diabetes and colorectal prognosis in cancer-specific survival, cardiovascular disease—specific survival, disease-free survival, and recurrence-free survival.

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The influence of diabetes on postoperative complications following colorectal surgery

et al. 2021

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Background Diabetes mellitus has been commonly associated with poor surgical outcomes. The aim of this meta-analysis was to assess the impact of diabetes on postoperative complications following colorectal surgery. Methods Medline, Embase and China National Knowledge Infrastructure electronic databases were reviewed from inception until May 9th 2020. Meta-analysis of proportions and comparative meta-analysis were conducted. Studies that involved patients with diabetes mellitus having colorectal surgery, with the inclusion of patients without a history of diabetes as a control, were selected. The outcomes measured were postoperative complications. Results Fifty-five studies with a total of 666,886 patients comprising 93,173 patients with diabetes and 573,713 patients without diabetes were included. Anastomotic leak (OR 2.407; 95% CI 1.837-3.155; p < 0.001), surgical site infections (OR 1.979; 95% CI 1.636-2.394; p < 0.001), urinary complications (OR 1.687; 95% CI 1.210-2.353; p = 0.002), and hospital readmissions (OR 1.406; 95% CI 1.349-1.466; p < 0.001) were found to be significantly higher amongst patients with diabetes following colorectal surgery. The incidence of septicemia, intra-abdominal infections, mechanical failure of wound healing comprising wound dehiscence and disruption, pulmonary complications, reoperation, and 30-day mortality were not significantly increased. Conclusions This meta-analysis and systematic review found a higher incidence of postoperative complications including anastomotic leaks and a higher re-admission rate. Risk profiling for diabetes prior to surgery and perioperative optimization for patients with diabetes is critical to improve surgical outcomes.

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Increased 30‐day mortality in patients with diabetes undergoing surgery for colorectal cancer

Abstract: Preexisting diabetes was associated with a higher short-term mortality in patients with CRC. No association between the type of antidiabetic medication and short-term mortality could be shown.

Cited by 16 publications

References 25 publications

The Effect of Diabetes on the Perioperative Outcomes of Colorectal Cancer Surgery Patients

The Effect of Diabetes on the Perioperative Outcomes of Colorectal Cancer Surgery Patients

The relationship between diabetes and colorectal cancer prognosis: A meta-analysis based on the cohort studies

The influence of diabetes on postoperative complications following colorectal surgery

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