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World Journal of Surgery

, Volume 37, Issue 10, pp 2257–2264 | Cite as

Effect of Diabetes on Outcomes in Patients Undergoing Emergent Cholecystectomy for Acute Cholecystitis

  • Efstathios KaramanosEmail author
  • Emre Sivrikoz
  • Elizabeth Beale
  • Linda Chan
  • Kenji Inaba
  • Demetrios Demetriades
Article

Abstract

Background

The purpose of the present study was to determine the prevalence of diabetes and its effect on surgical outcomes in patients undergoing emergent, in-patient cholecystectomy for acute cholecystitis. Some 8.3 % of the U.S. population has diabetes and this number is projected to rise to 21–33 % by 2050. Diabetes is considered to be associated with a higher incidence of acute cholecystitis; however, its impact on outcomes is unknown.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients with acute cholecystitis who underwent emergent in-patient cholecystectomy from 2004 to 2010. The study population was divided into two groups: diabetics and non-diabetics. Diabetics were further subdivided into those taking oral medication and those on insulin. Demographics, co-morbidities, and wound classification were compared with univariate analysis, and 30-day outcomes were compared with univariate and multivariate analyses.

Results

A total of 5,460 patients met the inclusion criteria. Of these 770 (14.10 %) had a diagnosis of diabetes. Mortality was higher for diabetics than for non-diabetics [4.4 vs 1.4 %, adjusted odds ratio (AOR) (95 % CI): 1.79 (1.09, 2.94), adj-p = 0.022]. Preoperative perforation rates were 25.1 and 13.0 %, respectively [AOR (95 % CI): 1.34 (1.09, 1.65), adj-p = 0.005]. The adjusted risk of cardiovascular events and renal failure was significantly higher for diabetics. Insulin treatment, but not oral medication, was associated with a significant increase in mortality, preoperative perforation, superficial surgical site infection, septic shock, cardiovascular incidents, and renal insufficiency.

Conclusions

In patients undergoing cholecystectomy for acute cholecystitis, diabetes increases the risk of mortality, cardiovascular events, and renal failure. Insulin-treated diabetics have more co-morbidities and poorer outcomes.

Keywords

Adjusted Odds Ratio Surgical Site Infection Cholecystitis Acute Cholecystitis National Surgical Quality Improvement Program 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the NSQIP are the source of the data used herein; the data have not been verified and ACS NSQIP is not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Conflicts of interest

The authors declare no conflicts of interest.

References

  1. 1.
  2. 2.
    Boyle JP, Thompson TJ, Gregg EW et al (2010) Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr 8:29PubMedCrossRefGoogle Scholar
  3. 3.
    Pagliarulo M, Fornari F, Fraquelli M et al (2004) Gallstone disease and related risk factors in a large cohort of diabetic patients. Dig Liver Dis 36:130–134PubMedCrossRefGoogle Scholar
  4. 4.
    Chapman BA, Wilson IR, Frampton CM et al (1966) Prevalence of gallbladder disease in diabetes mellitus. Dig Dis Sci 41:2222CrossRefGoogle Scholar
  5. 5.
    De Santis A, Attili AF, Ginanni Corradini S et al (1997) Gallstones and diabetes: a case-control study in a free-living population sample. Hepatology 25:787PubMedCrossRefGoogle Scholar
  6. 6.
    Noel RA, Braun DK, Patterson RE et al (2009) Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes: a retrospective cohort study. Diabetes Care 32:834–838PubMedCrossRefGoogle Scholar
  7. 7.
    Landau O, Deutsch AA, Kott I et al (1992) The risk of cholecystectomy for cholecystitis in diabetic patients. Hepatogastroenterology 39:437PubMedGoogle Scholar
  8. 8.
    Lipman JM, Claridge JA, Haridas M et al (2007) Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 142:556–563PubMedCrossRefGoogle Scholar
  9. 9.
    Bedirli A, Sözüer EM, Yüksel O et al (2001) Laparoscopic cholecystectomy for symptomatic gallstones in diabetic patients. J Laparoendosc Adv Surg Tech A 11:281–284PubMedCrossRefGoogle Scholar
  10. 10.
    Paajanen H, Suuronen S, Nordstrom P et al (2011) Laparoscopic versus open cholecystectomy in diabetic patients and postoperative outcome. Surg Endosc 25:764–770PubMedCrossRefGoogle Scholar
  11. 11.
    Banz V, Gsponer T, Candinas D et al (2011) Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg 254:964–970PubMedCrossRefGoogle Scholar
  12. 12.
    Cho JY, Han HS, Yoon YS et al (2010) Risk factors for acute cholecystitis and a complicated clinical course in patients with symptomatic cholelithiasis. Arch Surg 145:329–333PubMedCrossRefGoogle Scholar
  13. 13.
    Yamashita Y, Takada T, Kawarada Y et al (2007) Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 14:91–97PubMedCrossRefGoogle Scholar
  14. 14.
    Lau H, Lo CY, Patil NG et al (2006) Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc 20:82–87PubMedCrossRefGoogle Scholar
  15. 15.
    Laupland KB, Gregson DB, Zygun DA et al (2004) Severe bloodstream infections: a population-based assessment. Crit Care Med 32:992–997PubMedCrossRefGoogle Scholar
  16. 16.
    Michalia M, Kompoti M, Koutsikou A et al (2009) Diabetes mellitus is an independent risk factor for ICU-acquired bloodstream infections. Intensive Care Med 35:448–454PubMedCrossRefGoogle Scholar
  17. 17.
    Slynkova K, Mannino DM, Martin GS et al (2005) The role of body mass index and diabetes in the development of acute organ failure and subsequent mortality in an observational cohort. Crit Care 10:R137CrossRefGoogle Scholar
  18. 18.
    Graham BB, Keniston A, Gajic O et al (2010) Diabetes mellitus does not adversely affect outcomes from a critical illness. Crit Care Med 38:16–24PubMedCrossRefGoogle Scholar
  19. 19.
    Siegelaar SE, Hickmann M, Hoekstra JB et al (2011) The effect of diabetes on mortality in critically ill patients: a systematic review and meta-analysis. Crit Care 15:R205PubMedCrossRefGoogle Scholar
  20. 20.
    Finney SJ (2011) The good and the bad of diabetes mellitus in the critically ill. Crit Care 15:1018PubMedCrossRefGoogle Scholar
  21. 21.
    American College of Surgeons National Quality Improvement Program Data Collection. http://site.acsnsqip.org/program-specifics/data-collection-analysis-and-reporting/. Accessed 10 Sep 2013
  22. 22.
    Fuchshuber PR, Greif W, Tidwell CR et al (2012) The power of the national surgical quality improvement program—achieving a zero pneumonia rate in general surgery patients. Perm J 16:39–45PubMedGoogle Scholar
  23. 23.
    Ransohoff DF, Miller GL, Forsythe SB et al (1987) Outcome of acute cholecystitis in patients with diabetes mellitus. Ann Intern Med 106:829–832PubMedCrossRefGoogle Scholar
  24. 24.
    Bochicchio GV, Joshi M, Bochicchio K et al (2006) Incidence and impact of risk factors in critically ill trauma patients. World J Surg 30:114–118. doi: 10.1007/s00268-005-0203-x PubMedCrossRefGoogle Scholar
  25. 25.
    Ahmad R, Cherry RA, Lendel I et al (2007) Increased hospital morbidity among trauma patients with diabetes mellitus compared with age- and injury severity score-matched control subjects. Arch Surg 142:613–618PubMedCrossRefGoogle Scholar
  26. 26.
    Aydin C, Altaca G, Berber I et al (2006) Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg 13:155–159PubMedCrossRefGoogle Scholar
  27. 27.
    Nikfarjam M, Niumsawatt V, Sethu A et al (2011) Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford) 13:551–558CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Efstathios Karamanos
    • 1
    Email author
  • Emre Sivrikoz
    • 1
  • Elizabeth Beale
    • 2
  • Linda Chan
    • 1
  • Kenji Inaba
    • 1
  • Demetrios Demetriades
    • 1
  1. 1.Division of Acute Care Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Division of Endocrinology and Diabetes, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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