Type 2 Diabetes Mellitus and Adverse In-Hospital Outcomes after Nephroureterectomy

The effect of insulin dependence in type 2 diabetes mellitus (T2DM) on adverse in-hospital outcomes after nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) is unknown.

Descriptive statistics, propensity score matching (PSM), and multivariable regression models were applied to the National Inpatient Sample (2004-2019) UTUC patients treated with NU. T2DM was stratified between insulin-dependent (ID) and non-insulin-dependent (NID) subtypes.

In 10,761 NU patients, rates of ID-T2DM, and NID-T2DM were 2.7% and 19.1%, respectively. During the study period, ID-T2DM rates increased from 0.1 to 4.2% (estimated annual percentage change [EAPC]: +11.8%, p < 0.001), whereas NID-T2DM rates increased from 13.6 to 18.0% (EAPC: +1.1%, p = 0.045). After PSM, ID-T2DM patients (294 vs. 588 nondiabetic controls) exhibited higher rates of blood transfusions (+4.9%) and genitourinary complications (+7.8%), as well as higher total hospital charges (THCs; +9.3%). After multivariable adjustment, these increases translated into higher odds of blood transfusions (odds ratio [OR]: 1.88, p = 0.008) and genitourinary complications (OR: 1.40, p = 0.027), as well as higher THCs (incidence rate ratio [IRR]: 1.08, p < 0.001). NID-T2DM patients (2,051 vs. 4,102 nondiabetic controls) exhibited smaller increases in blood transfusions (+2.5%) and THC (+5.3%), corresponding to OR 1.28 (p = 0.002) and IRR 1.05 (p < 0.001), respectively.

Although ID-T2DM represents a relatively small subgroup, its rates increased over time. ID-T2DM was associated with higher rates of blood transfusions, genitourinary complications, and increased THC after NU. These findings suggest that ID-T2DM patients undergoing NU may represent a potential target population for perioperative optimization to reduce surgical morbidity and resource utilization.