Preoperative SGLT2 Inhibitors and Postoperative Complications After Tracheostomy in Type 2 Diabetes

Area of Science:

• Endocrinology
• Cardiology
• Surgical Outcomes

Background:

• Type 2 diabetes mellitus (T2DM) management involves various medications, including SGLT2 inhibitors.
• Open surgical tracheostomy (OST) is a procedure that carries specific postoperative risks.
• The perioperative impact of SGLT2 inhibitors in patients undergoing OST is not well-defined.

Purpose of the Study:

• To investigate the association between preoperative SGLT2 inhibitor use and postoperative complications in T2DM patients undergoing OST.
• To evaluate specific complications such as heart failure exacerbation and hypoglycemia.

Main Methods:

• Retrospective cohort study utilizing a multi-institutional electronic health record network.
• Identified T2DM patients undergoing OST between 2013-2024.
• Propensity score matching balanced cohorts based on demographics, comorbidities, and preoperative factors.

Main Results:

• SGLT2 inhibitor use was associated with increased odds of heart failure exacerbation at 90 and 180 days post-OST.
• Increased odds of hypoglycemia were observed at 180 days in the SGLT2 inhibitor group.
• No significant association was found for surgical site infection or tracheostomy stoma malfunction.

Conclusions:

• Preoperative SGLT2 inhibitor use in T2DM patients undergoing OST is linked to higher postoperative hypoglycemia and heart failure exacerbation.
• Findings suggest cautious perioperative management of SGLT2 inhibitors in high-risk airway surgery.
• Further prospective studies are warranted to establish optimal SGLT2 inhibitor discontinuation strategies.