Abstract - Science of Diabetic Complications

Topic: Complications

Abstract title
Evaluation of predictors of postoperative complications of major surgery programs in patients with type 2 diabetes.

Co-authors	
J.N. Giunta1, M.M. Castex1, A.M. Alvarez1, L.I. Capurro1, C.M. Elizondo2, F.C. Bonofiglio3, M.F. Russo Picasso1, L.E. LItwak1, P. Fainstein Day1, D.H. Giunta2, L.A. Grosembacher1.
1Hospital Italiano de Buenos Aires, Endocrinology, CABA, Argentina.
2Hospital Italiano de Buenos Aires, Department of Clinical Research, Caba, Argentina.
3Hospital Italiano de Buenos Aires, Anesthesiology, Caba, Argentina.

Background
Type 2 diabetes and its chronic complications are very common in the preoperative assessment of programmed surgeries. Patients with diabetes who require major cardiologic or general surgery have more complications in the immediate postoperative period such as infections, hospitalization time, cardiovascular events and death. The history of poor glycemic control and chronic complications could represent the risk factors for complications in the immediate postoperative period.

Aim
To identify factors predisposing to postoperative complications in major surgeries programmed in patients with type 2 diabetes.

Method
A prospective cohort study was conducted including patients with type 2 diabetes in the major programmed surgery plan. It was evaluated prior to surgery HbA1c, microalbuminuria, presence of retinopathy, neuropathy, nephropathy, type of major surgery and degree of glycemic control. The follow up was 45 postoperative days and patients with good metabolic control were considered as having HbA1c ≤ 7%. During the follow-up period it found the presence of infections, readmissions, cardiovascular events, cerebrovascular events, death and combined events.

Results
We included 228 patients, 167 of them with HbA1c ≤7% and 61 with HbA1c> 7%. In the group of patients with HbA1c ≤7%, the age was 65.5 years (SD 9.5) and males 50.9% (85). In the group of patients with HbA1c> 7%, the age was 63.4 years (SD 12.7) and males 62.3% (38). We detected 25 infections, 21 readmissions, 4 cardiovascular events, 1 cerebrovascular event, 2 deaths and 40 events combined. The median time of admitted to the hospital was the same in both groups (p 0.931).

The Hazard Ratio of HbA1c for infections of 0.9 (CI 95% 0.7-1.2) p 0.59, for readmissions 1.6 (CI 95% 0.7-3.8) p 0.296, for combined events it was 2.06 (CI 95% 1.1 - 3.85) p 0.024. It could not be estimated for cardiovascular, cerebrovascular and death events.

The combined event was associated with age with a Hazard Ratio 1.04 (95% CI 1.07, p 0.013), diabetic nephropathy with a Hazard Ratio 2.9 (95% CI 1.3-6.6, p 0.010), and diabetic retinopathy with a Hazard Ratio 4.3 (95% CI 1.7-11.2, p 0.002). There was no association with sex (p 0.272), BMI (p 0.424), physical activity (p 0.868), smoking (p 0.087), hypertension (p 0.979), dyslipidemia (p 0.213), coronary disease (P 0.255), active oncologic disease (p 0.608), charlson's index (p 0.095), peripheral vascular disease (p 0.573), neuropathy (p 0.464), and duration of surgery (p 0.090).

Discussion
This study identified as predictors of postoperative complications, the glycemic control measured by HbA1c, the age of the patient, the presence of nephropathy and  retinopathy for combined event. Therefore, these predictors prior to major surgery programs in patients with type 2 diabetes establishes an increase in postoperative complications.