The Effect Of Diabetes Mellitus And Nutritional Status On Outcomes In Patients Undergoing Lower Extremity Bypass And Open Aortoiliac Surgery
John C. Neill, Jr., MD, Mark P. Androes, MD, Joseph V. Blas, MD, Christopher G. Carsten, III, MD.
Prisma Health - Upstate, Greenville, SC, USA.
OBJECTIVES: Lower extremity bypass and open aortoiliac surgical procedures are associated with increased morbidity and mortality. Previous studies using varying nutritional indices have demonstrated increased incidence of postoperative complications in undernourished patients undergoing these procedures. The objective of this study is to evaluate the effect of diabetic status on postoperative outcomes in well-nourished and undernourished patients who underwent lower extremity bypass or open aortoiliac surgery.METHODS: We reviewed the charts of all patients at our institution who underwent lower extremity arterial bypass or open aortoiliac surgeries between February 1, 2016 and June 30, 2020. Using the controlling nutritional status (CONUT) score, which is calculated from preoperative albumin, cholesterol, and lymphocyte count, we divided our patients into normal and undernourished nutritional statuses. We evaluated post-operative outcomes of length of stay, 30-day readmission, 30-day mortality, 30-day reoperation, wound infection, amputation, and major amputation among diabetics and non-diabetics within each category. Outcomes were examined using Fisher’s exact test, with the exception of length of stay, which was examined by the Shapiro-Wilk test.RESULTS: A total of 376 patients who underwent lower extremity arterial bypass or open aortoiliac surgery during this time period were reviewed. 268 patients met exclusion criteria. Of the 108 patients included in the study, 65 were noted to be undernourished and 43 demonstrated normal nutritional status. Interestingly, there were no statistically significant differences in any of the above-mentioned post-operative outcomes between undernourished patients and those with normal nutritional status. Among patients with normal nutritional status, there were no statistically significant differences in post-operative outcomes between diabetics and non-diabetics. Among undernourished patients, there was a statistically significant increase in 30-day re-admission (P = 0.033), overall amputation (P = 0.001), and major amputation (P = 0.006) in diabetics compared to non-diabetics.CONCLUSIONS: The results of this study suggest that undernourished patients who are diabetic may be at greater risk for certain post-operative complications than non-diabetics when undergoing lower extremity bypass or open aortoiliac surgical procedures. Diabetic status does not appear to significantly influence post-operative outcomes in well-nourished patients. While our results did not show a statistically significant difference in post-operative outcomes between overall well-nourished and undernourished patients, undernourished patients may still benefit from a pre-operative nutritional optimization program. Such a program would likely be particularly beneficial in diabetic patients.
Back to 2021 ePosters