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. 2018 Jun;41(6):1268-1274.
doi: 10.2337/dc17-2046. Epub 2018 Apr 4.

Influence of Diabetes on Trends in Perioperative Cardiovascular Events

Jonathan D Newman  1 , Tanya Wilcox  2 , Nathaniel R Smilowitz  2 , Jeffrey S Berger  2
Affiliations

Influence of Diabetes on Trends in Perioperative Cardiovascular Events

Jonathan D Newman et al. Diabetes Care. 2018 Jun.

Abstract

Objective: Patients undergoing noncardiac surgery frequently have diabetes mellitus (DM) and an elevated risk of cardiovascular disease. It is unknown whether temporal declines in the frequency of perioperative major adverse cardiovascular and cerebrovascular events (MACCEs) apply to patients with DM.

Research design and methods: Patients ≥45 years of age who underwent noncardiac surgery from January 2004 to December 2013 were identified using the U.S. National Inpatient Sample. DM was identified using ICD-9 diagnosis codes. Perioperative MACCEs (in-hospital all-cause mortality, acute myocardial infarction, or acute ischemic stroke) by DM status were evaluated over time.

Results: The final study sample consisted of 10,581,621 hospitalizations for major noncardiac surgery; DM was present in ∼23% of surgeries and increased over time (P for trend <0.001). Patients with DM experienced MACCEs in 3.3% of surgeries vs. 2.8% of surgeries for patients without DM (P < 0.001). From 2004 to 2013, the odds of perioperative MACCEs after multivariable adjustment increased by 6% (95% CI 2-9) for DM patients, compared with an 8% decrease (95% CI -10 to -6) for patients without DM (P for interaction <0.001). Trends for individual end points were all less favorable for patients with DM versus those without DM.

Conclusions: In an analysis of >10.5 million noncardiac surgeries from a large U.S. hospital admission database, perioperative MACCEs were more common among patients with DM versus those without DM. Perioperative MACCEs increased over time and individual end points were all less favorable for patients with DM. Our findings suggest that a substantial unmet need exists for strategies to reduce the risk of perioperative cardiovascular events among patients with DM.

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Figures

Figure 1
Figure 1
Trends in rates by DM status of perioperative MACCEs. A: MACCEs. B: Death. C: AMI. D: Stroke.
Figure 2
Figure 2
Trends in adjusted odds of perioperative MACCEs by DM status over time. A: MACCEs. B: Death. C: AMI. D: Stroke. Multivariable models include age, sex, race/ethnicity, obesity, tobacco use, hypertension, hyperlipidemia, chronic kidney disease, end-stage renal disease, coronary artery disease, prior revascularization with either PCI or CABG, peripheral arterial disease, valvular heart disease, congestive heart failure, prior venous thromboembolism, chronic lung disease, alcohol abuse, malignancy, anemia, elective hospitalization, noncardiac surgery subtype, and year of surgery as covariates.
Figure 3
Figure 3
Adjusted percentage change in odds of perioperative MACCEs and individual end points, 2004–2013.
See this image and copyright information in PMC

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