Diabetes mellitus and perioperative outcomes: a scoping review of the literature

Abstract

Background: Diabetes mellitus (DM) is frequently encountered in the perioperative period. DM may increase the risk of adverse perioperative outcomes owing to the potential vascular complications of DM. We conducted a scoping review to examine the association between DM and adverse perioperative outcomes.

Methods: A systematic search strategy of the published literature was built and applied in multiple databases. Observational studies examining the association between DM and adverse perioperative outcomes were included. Abstract screening determined full texts suitable for inclusion. Core information was extracted from each of the included studies including study design, definition of DM, type of DM, surgical specialties, and outcomes. Only primary outcomes are reported in this review.

Results: The search strategy identified 2363 records. Of those, 61 were included and 28 were excluded with justification. DM was mostly defined by either haemoglobin A1c (HbA1c) or blood glucose values (19 studies each). Other definitions included 'prior diagnosis' or use of medication. In 17 studies the definition was unclear. Type 2 DM was the most frequently studied subtype. Five of seven studies found DM was associated with mortality, 5/13 reported an association with 'complications' (as a composite measure), and 12/17 studies found DM was associated with 'infection'. Overall, 33/61 studies reported that DM was associated with the primary outcome measure.

Conclusion: Diabetes mellitus is inconsistently defined in the published literature, which limits the potential for pooled analysis. Further research is necessary to determine which cohort of patients with DM are most at risk of adverse postoperative outcomes, and how control influences this association.

Keywords: blood glucose; complications; diabetes mellitus; glycated haemoglobin; postoperative complications; scoping review.

Fig 1

PRISMA flowchart demonstrating the full scoping review process from initial search to abstract screening and full text assessment. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Fig 2

Bubble plot of diabetes mellitus definitions. Bubble plot depicting the range of definitions used in the published literature studying the association between diabetes mellitus and adverse postoperative outcomes. ∗OGTT, oral glucose tolerance test. HbA1c, haemoglobin A1c.