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|Title:||The Presence of Diabetes and Higher HbA1cAre Independently Associated With Adverse Outcomes After Surgery.|
|Authors:||Yong, Priscilla H;Weinberg, Laurence;Torkamani, Niloufar;Churilov, Leonid;Robbins, Raymond J;Ma, Ronald;Bellomo, Rinaldo;Lam, Que T;Burns, James D;Hart, Graeme K;Lew, Jeremy F;Mårtensson, Johan;Story, David A;Motley, Andrew N;Johnson, Douglas F;Zajac, Jeffrey D;Ekinci, Elif I|
|Affiliation:||Department of Medicine, Austin Health, the University of Melbourne, Heidelberg, Victoria, Australia|
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
The Florey Institute of Neuroscience & Mental Health, Melbourne, Victoria, Australia
Department of Administrative Informatics, Austin Health, Heidelberg, Victoria, Australia
Clinical Costing Finance, Austin Health, Heidelberg, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia..
Centre for Integrated Critical Care, University of Melbourne, Parkville, Victoria, Australia
Department of Pathology, Austin Health, Heidelberg, Victoria, Australia
Clinical Informatics Unit, Austin Health, Heidelberg, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Section of Anesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
Quality and Patient Safety Unit, Austin Health, Heidelberg, Victoria, Australia
Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia
Australian and New Zealand Intensive Care Society Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
|Citation:||Diabetes care 2018; 41(6): 1172-1179|
|Abstract:||Limited studies have examined the association between diabetes and HbA1cwith postoperative outcomes. We investigated the association of diabetes, defined categorically and HbA1cas a continuous measure, with postoperative outcomes. In this prospective, observational study, we measured the HbA1cof surgical inpatients age ≥54 years at a tertiary hospital between May 2013 and January 2016. Patients were diagnosed with diabetes if they had preexisting diabetes or an HbA1c≥6.5% (48 mmol/mol) or with prediabetes if they had an HbA1cbetween 5.7-6.4% (39-48 mmol/mol). Patients with an HbA1c<5.7% (39 mmol/mol) were categorized as having normoglycemia. Baseline demographic and clinical data were obtained from hospital records, and patients were followed for 6 months. Random-effects logistic and negative binomial regression models were used for analysis, treating surgical units as random effects. We undertook classification and regression tree (CART) analysis to design a 6-month mortality risk model. Of 7,565 inpatients, 30% had diabetes, and 37% had prediabetes. After adjusting for age, Charlson comorbidity index (excluding diabetes and age), estimated glomerular filtration rate, and length of surgery, diabetes was associated with increased 6-month mortality (adjusted odds ratio [aOR] 1.29 [95% CI 1.05-1.58];P= 0.014), major complications (1.32 [1.14-1.52];P< 0.001), intensive care unit (ICU) admission (1.50 [1.28-1.75];P< 0.001), mechanical ventilation (1.67 [1.32-2.10];P< 0.001), and hospital length of stay (LOS) (adjusted incidence rate ratio [aIRR] 1.08 [95% CI 1.04-1.12];P< 0.001). Each percentage increase in HbA1cwas associated with increased major complications (aOR 1.07 [1.01-1.14];P= 0.030), ICU admission (aOR 1.14 [1.07-1.21];P< 0.001), and hospital LOS (aIRR 1.05 [1.03-1.06];P< 0.001). CART analysis confirmed a higher risk of 6-month mortality with diabetes in conjunction with other risk factors. Almost one-third of surgical inpatients age ≥54 years had diabetes. Diabetes and higher HbA1cwere independently associated with a higher risk of adverse outcomes after surgery.|
|Appears in Collections:||Journal articles|
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