Type 2 Diabetes Mellitus Versus Adverse In-Hospital Outcomes After Partial or Radical Nephrectomy

The effect of insulin-dependence in type 2 diabetes mellitus (T2DM) on adverse in-hospital outcomes after partial (PN) or radical nephrectomy (RN) is unknown.

Descriptive statistics, propensity score matching (PSM), and multivariable logistic regression were applied to the National Inpatient Sample (2004-2019) patients with kidney cancer who underwent nephrectomy. T2DM was stratified between insulin-dependent (ID) and noninsulin-dependent (NID) subtypes.

In 31,909 patients treated with PN, rates of ID-T2DM versus NID-T2DM were 3.5% versus 20.0%, and 3.4% versus 20.9% in 57,029 patients treated with RN. During the study period, ID-T2DM rates increased from 0.02% to 5.4% (270-fold) in PN and from 0.3% to 6.3% (21-fold) in RN. NID-T2DM rates increased from 17.4% to 20.2% (1.2-fold) in PN and from 17.0% to 21.6% (1.3-fold) in RN. After PSM, patients with ID-T2DM who underwent PN (1109 versus 5545 nondiabetic controls) exhibited higher rates of adverse in-hospital outcomes with significant increases in six examined categories (7.9-2.3%; OR 1.6-1.3). ID-T2DM had a weaker effect (6.0-0.6%; OR 3.0-1.2) in patients treated with RN (1961 versus 3922 controls). Finally, NID-T2DM exerted a modest effect (3.5-2.5%, OR 1.4-1.2) in patients treated with PN (6400 versus 6400 controls) and the weakest effect (2.6-0.8%, OR 1.2-1.1) in patients treated with RN (11,924 versus 11,924 controls).

Although ID-T2DM is relatively rare, its rates increased drastically over time. ID-T2DM was most strongly associated with adverse in-hospital outcomes in patients treated with PN, both in absolute and relative terms. Therefore, patients with ID-T2DM undergoing PN may represent a particularly relevant target population for perioperative management optimization with respect to surgical risk.