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Diabetes Mellitus and Increased Postoperative Risk of Acute Renal Failure After Hepatectomy for Hepatocellular Carcinoma: A Nationwide Population-Based Study

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to determine the effects of diabetes mellitus (DM) on the risk of surgical mortality and morbidity in patients undergoing hepatectomy for hepatocellular carcinoma (HCC).

Methods

We identified 2,962 DM patients who underwent a hepatectomy for HCC from 2000 to 2010. The non-DM control cohort consisted of 2,962 patients who also received a hepatectomy during the same period. Age, sex, comorbidities, and year of admission were all matched between the 2 cohorts.

Results

The prevalence of preoperative coexisting medical conditions was comparable between the DM and non-DM cohorts, except the percentage of patients undergoing major hepatectomy (lobectomy; 18.1 % in the DM cohort vs. 20.4 % in the non-DM cohort; p = 0.02).The hazard ratio (HR) of 30-day postoperative mortality in the DM patients after hepatectomy was 1.17 [95 % confidence interval (CI) 0.75–1.84] after adjustment. The DM cohort exhibited a significantly higher risk of postoperative septicemia (adjusted hazard ratio, 1.45; 95 % CI 1.06–2.00) and acute renal failure (adjusted hazard ratio, 1.70; 95 % CI 1.01–2.84) compared with that of the non-DM cohort, but this higher risk was not associated with the increased risk of other major morbidities, including pneumonia, stroke, and myocardial infarction. Further analysis showed that major hepatectomy (lobectomy) in DM patients carried higher risks of septicemia and acute renal failure. In multiple regression models, preoperative diabetes-related comorbidities were not significantly associated with 30-day postoperative mortality.

Conclusions

DM is associated with a significantly high risk of septicemia and acute renal failure, but not with other major complications or mortality, after hepatectomy for HCC.

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Acknowledgment

The study was supported in part by the study projects DMR-103-018 and CMU102-BC-2 of China Medical University and Hospital, Taiwan Ministry of Health and Welfare Clinical Trial and Research Center and for Excellence (DOH102-TD-B-111-004), and Taiwan Ministry of Health and Welfare Cancer Research Center for Excellence (MOHW103-TD-B-111-03). The role of study sponsors in the study was in the collection of data from the NHIRD

Disclosures

All authors report no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan

    Ming-Shian Tsai MD & Po-Huang Lee MD

  2. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Cheng-Li Lin MSc

  3. College of Medicine, China Medical University, Taichung, Taiwan

    Cheng-Li Lin MSc

  4. Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan

    Shih-Ni Chang MSc

  5. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

    Chia-Hung Kao MD

  6. Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Chia-Hung Kao MD

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  1. Ming-Shian Tsai MD
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  2. Cheng-Li Lin MSc
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Correspondence to Chia-Hung Kao MD.

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Tsai, MS., Lin, CL., Chang, SN. et al. Diabetes Mellitus and Increased Postoperative Risk of Acute Renal Failure After Hepatectomy for Hepatocellular Carcinoma: A Nationwide Population-Based Study. Ann Surg Oncol 21, 3810–3816 (2014). https://doi.org/10.1245/s10434-014-3777-4

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  • DOI: https://doi.org/10.1245/s10434-014-3777-4

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