Adverse Outcomes After Noncardiac Surgery in Patients With Diabetes

A nationwide population-based retrospective cohort study

  1. Ta-Liang Chen, MD, PHD4,5,6
  1. 1Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
  2. 2Department of Surgery, China Medical University Hospital, Taichung, Taiwan
  3. 3School of Medicine, China Medical University, Taichung, Taiwan
  4. 4Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
  5. 5Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
  6. 6School of Medicine, Taipei Medical University, Taipei, Taiwan
  7. 7Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan
  8. 8School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
  1. Corresponding author: Ta-Liang Chen, tlc{at}
  1. C.-C.Y. and C.-C.L. contributed equally to this work.


OBJECTIVE To investigate whether diabetes affects perioperative complications or mortality and to gauge its impact on medical expenditures for noncardiac surgeries.

RESEARCH DESIGN AND METHODS With the use of reimbursement claims from the Taiwan National Health Insurance system, we performed a population-based cohort study of patients with and without diabetes undergoing noncardiac surgeries. Outcomes of postoperative complications, mortality, hospital stay, and medical expenditures were compared between patients with and without diabetes.

RESULTS Diabetes increased 30-day postoperative mortality (odds ratio 1.84 [95% CI 1.46–2.32]), particularly among patients with type 1 diabetes or uncontrolled diabetes and patients with preoperative diabetes-related comorbidities, such as eye involvement, peripheral circulatory disorders, ketoacidosis, renal manifestations, and coma. Compared with nondiabetic control patients, coexisting medical conditions, such as renal dialysis (5.17 [3.68–7.28]), liver cirrhosis (3.59 [2.19–5.88]), stroke (2.87 [1.95–4.22]), mental disorders (2.35 [1.71–3.24]), ischemic heart disease (2.08 [1.45–2.99]), chronic obstructive pulmonary disease (1.96 [1.29–2.97]), and hyperlipidemia (1.94 [1.01–3.76]) were associated with mortality for patients with diabetes undergoing noncardiac surgery. Patients with diabetes faced a higher risk of postoperative acute renal failure (3.59 [2.88–4.48]) and acute myocardial infarction (3.65 [2.43–5.49]). Furthermore, diabetes was associated with prolonged hospital stay (2.30 [2.16–2.44]) and increased medical expenditures (1.32 [1.25–1.40]).

CONCLUSIONS Diabetes increases postoperative 30-day mortality, complications, and medical expenditures in patients undergoing in-hospital noncardiac surgeries.

  • Received April 1, 2013.
  • Accepted April 11, 2013.

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This Article

  1. Diabetes Care
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