The Influence Of Diabetes Status And Management On Lower Extremity Bypass Outcomes In A National Cohort
James M. Dittman, BS, Kedar S. Lavingia, MD, Robert A. Larson, MD.
Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
OBJECTIVES: While advances in clinical care have positively impacted morbidity and mortality for diabetic patients over the last decade, these patients remain at elevated risk for postoperative adverse events. We set forth to investigate the influence of diabetic status and management on modern lower extremity bypass outcomes using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. METHODS: All elective cases in the NSQIP Targeted Lower Extremity Open database from 2015-2019 were paired with the Participant User File utilizing Case IDs. Cohorts were defined by preoperative diabetic status and management. Extended hospital stay was defined as top quartile postoperative length of stay. Aggregate demographics, perioperative factors, and 30-day outcomes were compared between cohorts using unpaired t-test and Fisher’s exact test. Adjusted odds-ratios were generated by applying a multivariate binary logistic regression model to predict 30-day outcomes using diabetic status, age, gender, prior ipsilateral open versus percutaneous intervention, conduit type, functional independence, and preoperative hypertension, smoking, COPD, CHF, and dialysis dependance as covariates. RESULTS: Over the study period, 8,155 complete recorded cases were performed at an average age of 67.7±10.5 years in a predominantly male (69%) cohort. 3,501 cases (43%) involved diabetic patients, 55% of whom were insulin dependent. Once covariate adjusted, non-insulin dependent diabetes related only to extended postoperative stay and insulin dependence significantly related to multiple outcomes (Table). Mortality was not significantly related to diabetic status. CONCLUSIONS: Insulin-dependent diabetes was found to nearly double covariate-adjusted odds for amputation, extended course, and MI or stroke at 30 days in lower extremity bypass patients. Future studies should investigate whether perioperative glucose control further influences these postoperative outcomes.
|30-Day Postoperative Outcome||Non-Diabetic||Non-Insulin Dependent Diabetes(aOR; 95% CI; p value)||Insulin Dependent Diabetes(aOR; 95% CI; p value)|
|Operating Room Return||Ref||NS||1.44; 1.23-1.70; <0.001|
|Readmission||Ref||NS||1.58; 1.35-1.85; <0.001|
|Extended Hospital Course||Ref||1.27; 1.10-1.48; 0.002||1.89; 1.65-2.16; <0.001|
|Worsened ABI||Ref||NS||1.27; 1.06-1.53; 0.011|
|SNF Disposition||Ref||NS||1.82; 1.53-2.16; <0.001|
|Amputation||Ref||NS||1.85; 1.22-2.79; 0.004|
|Bleeding||Ref||NS||1.43; 1.21-1.69; <0.001|
|MI or Stroke||Ref||NS||1.91; 1.39-2.64; <0.001|
|Wound Infection/Complication||Ref||NS||1.31; 1.12-1.53; <0.001|
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