CV, cerebrovascular risks increase after noncardiac surgery in adults with diabetes
Adults with diabetes have a higher risk for major cardiovascular and cerebrovascular events, including mortality and acute myocardial infarction, after major noncardiac surgical procedures compared with adults without diabetes, and risk for perioperative stroke was increased without regard to diabetes status, study data show.
Jonathan D. Newman, MD, MPH, assistant professor in the division of cardiology, department of medicine at New York University School of Medicine, and colleagues evaluated data from the U.S. National Inpatient Sample on 2,438,204 adults with (mean age, 66.72 years; 51.7% women; 59.1% white) and 8,143,417 without (mean age, 65.44 years; 58.1% women; 66.8% white) diabetes who underwent noncardiac surgery between 2004 and 2013 to determine the frequency of perioperative major adverse CV and cerebrovascular events (MACCE), including in-hospital all-cause mortality, acute MI or acute ischemic stroke.
MACCE occurred in more participants with diabetes vs. without diabetes (3.3% vs. 2.8%; adjusted OR = 0.94; 95% CI, 0.93-0.95). The aOR for MACCE was 1.41 (95% CI, 1.38-1.43) for participants with uncontrolled diabetes vs. those without diabetes.
Researchers noted a drop in the number of perioperative MACCE per 100,000 surgeries during the study period, with greater decrease among participants without diabetes vs. those with diabetes (730 vs. 222; P < .001 for both). The odds of perioperative MACCE increased in participants with diabetes (6%) and decreased in participants without diabetes (8%; P for interaction < .001).
A decrease was also observed in the number of deaths per 100,000 surgeries during the study period; the reduction was greater among participants without diabetes vs. those with diabetes (787 vs. 383; P < .001 for both). The adjusted odds for perioperative mortality decreased by 24% among participants without diabetes vs. 14% among with participants with diabetes (P for interaction < .001). The odds for perioperative acute MI decreased by 16% among participants without diabetes vs. 7% among those with diabetes (P for interaction < .001). The odds for perioperative stroke increased 73% among participants without diabetes vs. 96% among participants with diabetes (P for interaction < .001).
“This analysis highlights the need for additional strategies to reduce the risk of perioperative cardiovascular complications among patients with diabetes, and the need for additional study to confirm the increases in perioperative stroke observed for patients with and without diabetes,” the researchers wrote. – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.