Influence of Diabetes on Trends in Perioperative Cardiovascular Events

Area of Science:

• Cardiology
• Endocrinology
• Surgical Outcomes

Background:

• Patients with diabetes mellitus (DM) are at increased risk for cardiovascular disease.
• Noncardiac surgery patients frequently have DM, a condition associated with higher perioperative risks.
• Temporal trends in perioperative cardiovascular events are not well-established for patients with DM.

Purpose of the Study:

• To investigate temporal trends in major adverse cardiovascular and cerebrovascular events (MACCEs) for patients with and without diabetes mellitus (DM) undergoing noncardiac surgery.
• To compare the frequency and trends of perioperative MACCEs between DM and non-DM patient groups.

Main Methods:

• Analysis of over 10.5 million hospitalizations for major noncardiac surgery from the U.S. National Inpatient Sample (2004-2013).
• Identification of diabetes mellitus (DM) using ICD-9 diagnosis codes.
• Evaluation of perioperative MACCEs (mortality, myocardial infarction, ischemic stroke) by DM status over time, with multivariable adjustment.

Main Results:

• Diabetes mellitus (DM) was present in approximately 23% of surgeries and increased over the study period.
• Patients with DM had a higher incidence of MACCEs (3.3%) compared to those without DM (2.8%).
• From 2004 to 2013, the odds of perioperative MACCEs increased for DM patients (6%) but decreased for non-DM patients (-8%), with a significant interaction (P < 0.001).

Conclusions:

• Perioperative major adverse cardiovascular and cerebrovascular events (MACCEs) are more common in patients with diabetes mellitus (DM) undergoing noncardiac surgery.
• Unlike patients without DM, the risk of MACCEs has increased over time for patients with DM.
• Effective strategies are needed to mitigate perioperative cardiovascular risks in patients with DM.