Risk Factors for Anastomotic Leak and Mortality in Diabetic Patients Undergoing Colectomy

Abstract

To determine the risk factors in diabetic patients that are associated with increased postcolectomy mortality and anastomotic leak. Design: A prospectively acquired statewide database of patients who underwent colectomy was reviewed. Primary risk factors were diabetes mellitus, hyperglycemia (glucose level Ն140 mg/dL), steroid use, and emergency surgery. Categorical analysis, univariate logistic regression, and multivariate regression were used to evaluate the effects of these risk factors on outcomes. Setting: Participating hospitals within the Michigan Surgical Quality Collaborative. Patients: Database review of patients from hospitals within the Michigan Surgical Quality Collaborative. Main Outcome Measures: Anastomotic leak and 30day mortality rate. Results: Of 5123 patients, 153 (3.0%) had leaks and 153 (3.0%) died. Preoperative hyperglycemia occurred in 15.6% of patients, only 54% of whom were known to have diabetes. Multivariate analysis showed that the risk of leak for patients with and without diabetes increased only by preoperative steroid use (PϽ .05). Mortality among diabetic patients was associated with emergency surgery (P Ͻ.01) and anastomotic leak (PϽ .05); it was not associated with hyperglycemia. Mortality among nondiabetic patients was associated with hyperglycemia (P Ͻ .005). The presence of an anastomotic leak was associated with increased mortality among diabetic patients (26.3% vs 4.5%; P Ͻ .001) compared with nondiabetic patients (6.0% vs 2.5%; PϽ .05). Conclusions: The presence of diabetes did not have an effect on the presence of an anastomotic leak, but diabetic patients who had a leak had more than a 4-fold higher mortality compared with nondiabetic patients. Preoperative steroid use led to increased rates of anastomotic leak in diabetic patients. Mortality was associated with hyperglycemia for nondiabetic patients only. Improved screening may identify high-risk patients who would benefit from perioperative intervention.

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

“…A study of US veterans that assessed 30‐day mortality following surgery for CRC showed that patients with preexisting DM had a significantly increased risk of developing AL . Other studies were unable to show an increased risk of AL among patients with DM and CRC . In our study DM was not found to be a risk factor for AL, and patients with diabetes were not more likely to have a permanent stoma than non‐DM patients.…”

External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy

“…A large statewide collaborative study of 5123 patients evaluated the anastomotic leakage rate and mortality after colectomy in diabetic patients. Although diabetes did not appear to be a risk factor for anastomotic leakage, diabetic patients who had leakage had a four‐fold higher mortality than nondiabetic patients . Even though diabetes was not associated with pouch failure in our study, pouch survival rates were considerably decreased in patients who had anastomotic leakage.…”

Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey

“…An exception was the study of Ziegler et al . , which included 5123 patients, 214 of whom were treated with steroids. Ziegler et al .…”

“…Unfortunately, corticosteroids have been linked to numerous, and sometimes severe, complications. Although corticosteroids are known to impair wound healing, their influence on the healing of colorectal anastomoses remains unclear and studies have reported conflicting results [6,[8][9][10][11][12][13][14][15][16][17][18].…”