Document Detail


Predictors of postoperative complications in the patient with diabetes mellitus.
MedLine Citation:
PMID:  18191074     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Since patients with diabetes mellitus have increased rates of cardiovascular morbidity and mortality, it is critical to evaluate cardiovascular risk perioperatively. Although several preoperative risk indices have been developed, including the Goldman and Detsky indices, none have been designed specifically for diabetic patients. In this study, we attempted to identify predictors of postoperative cardiac and noncardiac complications in diabetic patients undergoing elective general surgery. STUDY DESIGN: A cohort of 107 diabetic patients undergoing elective surgery was assembled. Basic demographic and clinical data were recorded perioperatively, and all patients were followed up prospectively daily for 7 days postoperatively. Patients were interviewed at 5 years postoperatively. Univariate and multivariate analyses were performed to identify predictors of postoperative complications and long-term cardiac and vascular morbidity and mortality. RESULTS: Total cardiac complications and myocardial infarction were predicted by the Goldman index. Wound complications were not predicted by any of the variables studied. At 5 years postoperatively, cardiac and vascular deaths and events were predicted by age, history of myocardial infarction or stroke, presence of vascular disease, Goldman index, duration of diabetes or hypertension, Charlson comorbidity score, and postoperative myocardial infarction or cardiac arrest. Blood sugar control during surgery was not predictive of any short- or long-term cardiovascular complications. CONCLUSIONS: Total cardiac complications had a significant preoperative predictor: the Goldman index. Both preoperative and postoperative variables and indices predicted long-term cardiac and vascular complications. Further study is necessary to investigate these relationships to better assess and manage the diabetic patient in the perioperative setting.
Authors:
Laurent S Tao; C Ronald Mackenzie; Mary E Charlson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of diabetes and its complications     Volume:  22     ISSN:  1056-8727     ISO Abbreviation:  J. Diabetes Complicat.     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2008-01-14     Completed Date:  2008-03-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9204583     Medline TA:  J Diabetes Complications     Country:  United States    
Other Details:
Languages:  eng     Pagination:  24-8     Citation Subset:  IM    
Affiliation:
The New York Hospital, New York, NY, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiovascular Diseases / diagnosis,  etiology
Diabetes Complications / diagnosis,  etiology*
Diabetes Mellitus, Type 1 / complications*
Diabetes Mellitus, Type 2 / complications*
Female
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / diagnosis,  etiology
Postoperative Complications / diagnosis,  etiology*
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Factors
Sensitivity and Specificity
Severity of Illness Index

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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