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

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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.

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References

  1. http://www.cdc.gov/diabetes/pubs/estimates11.htm

  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 8:29

    Article  PubMed  Google Scholar 

  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 36:130–134

    Article  PubMed  CAS  Google Scholar 

  4. Chapman BA, Wilson IR, Frampton CM et al (1966) Prevalence of gallbladder disease in diabetes mellitus. Dig Dis Sci 41:2222

    Article  Google Scholar 

  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 25:787

    Article  PubMed  Google Scholar 

  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 32:834–838

    Article  PubMed  Google Scholar 

  7. Landau O, Deutsch AA, Kott I et al (1992) The risk of cholecystectomy for cholecystitis in diabetic patients. Hepatogastroenterology 39:437

    PubMed  CAS  Google Scholar 

  8. Lipman JM, Claridge JA, Haridas M et al (2007) Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 142:556–563

    Article  PubMed  Google Scholar 

  9. Bedirli A, Sözüer EM, Yüksel O et al (2001) Laparoscopic cholecystectomy for symptomatic gallstones in diabetic patients. J Laparoendosc Adv Surg Tech A 11:281–284

    Article  PubMed  CAS  Google Scholar 

  10. Paajanen H, Suuronen S, Nordstrom P et al (2011) Laparoscopic versus open cholecystectomy in diabetic patients and postoperative outcome. Surg Endosc 25:764–770

    Article  PubMed  Google Scholar 

  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 254:964–970

    Article  PubMed  Google Scholar 

  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 145:329–333

    Article  PubMed  Google Scholar 

  13. Yamashita Y, Takada T, Kawarada Y et al (2007) Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 14:91–97

    Article  PubMed  Google Scholar 

  14. Lau H, Lo CY, Patil NG et al (2006) Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc 20:82–87

    Article  PubMed  CAS  Google Scholar 

  15. Laupland KB, Gregson DB, Zygun DA et al (2004) Severe bloodstream infections: a population-based assessment. Crit Care Med 32:992–997

    Article  PubMed  Google Scholar 

  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 35:448–454

    Article  PubMed  CAS  Google Scholar 

  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:R137

    Article  Google Scholar 

  18. Graham BB, Keniston A, Gajic O et al (2010) Diabetes mellitus does not adversely affect outcomes from a critical illness. Crit Care Med 38:16–24

    Article  PubMed  Google Scholar 

  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:R205

    Article  PubMed  Google Scholar 

  20. Finney SJ (2011) The good and the bad of diabetes mellitus in the critically ill. Crit Care 15:1018

    Article  PubMed  Google Scholar 

  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. 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 16:39–45

    PubMed  Google Scholar 

  23. Ransohoff DF, Miller GL, Forsythe SB et al (1987) Outcome of acute cholecystitis in patients with diabetes mellitus. Ann Intern Med 106:829–832

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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 142:613–618

    Article  PubMed  Google Scholar 

  26. Aydin C, Altaca G, Berber I et al (2006) Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg 13:155–159

    Article  PubMed  Google Scholar 

  27. Nikfarjam M, Niumsawatt V, Sethu A et al (2011) Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford) 13:551–558

    Article  Google Scholar 

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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.

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Authors and Affiliations

  1. Division of Acute Care Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Efstathios Karamanos, Emre Sivrikoz, Linda Chan, Kenji Inaba & Demetrios Demetriades

  2. Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Elizabeth Beale

Authors
  1. Efstathios Karamanos
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  2. Emre Sivrikoz
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  3. Elizabeth Beale
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  4. Linda Chan
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  5. Kenji Inaba
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  6. Demetrios Demetriades
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Correspondence to Efstathios Karamanos.

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Karamanos, E., Sivrikoz, E., Beale, E. et al. Effect of Diabetes on Outcomes in Patients Undergoing Emergent Cholecystectomy for Acute Cholecystitis. World J Surg 37, 2257–2264 (2013). https://doi.org/10.1007/s00268-013-2086-6

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  • DOI: https://doi.org/10.1007/s00268-013-2086-6

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