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

Area of Science:

• Urology
• Oncology
• Endocrinology

Background:

• The impact of insulin-dependent type 2 diabetes mellitus (ID-T2DM) on outcomes following nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) remains largely uncharacterized.
• Understanding these effects is crucial for optimizing perioperative care in this growing patient population.

Purpose of the Study:

• To investigate the association between insulin-dependent type 2 diabetes mellitus (ID-T2DM) and adverse in-hospital outcomes after NU for UTUC.
• To compare outcomes between insulin-dependent (ID) and non-insulin-dependent (NID) T2DM subtypes and non-diabetic patients.

Main Methods:

• Analysis of the National Inpatient Sample (2004-2019) database for patients undergoing NU for UTUC.
• Stratification of T2DM into insulin-dependent (ID) and non-insulin-dependent (NID) subtypes.
• Application of descriptive statistics, propensity score matching (PSM), and multivariable regression models to assess outcomes.

Main Results:

• Rates of ID-T2DM significantly increased from 0.1% to 4.2% during the study period (EAPC: +11.8%).
• After PSM, ID-T2DM patients showed higher rates of blood transfusions (+4.9%), genitourinary complications (+7.8%), and total hospital charges (+9.3%) compared to non-diabetic controls.
• NID-T2DM patients also experienced increased blood transfusions (+2.5%) and total hospital charges (+5.3%), but to a lesser extent than ID-T2DM patients.

Conclusions:

• ID-T2DM, despite being a smaller subgroup, is associated with significantly increased surgical morbidity and healthcare costs after NU for UTUC.
• These findings highlight ID-T2DM patients as a target population for perioperative optimization strategies.
• Perioperative optimization may reduce surgical complications and resource utilization in ID-T2DM patients undergoing NU.