General surgery considerations in the diabetic patient

Early studies implicated diabetes as a risk factor for serious postoperative complications, but many of these conclusions have not withstood the scrutiny of analyses correcting for comorbid conditions. Asymptomatic gallstones in the diabetic patient are not an indication for preemptive surgery. Biliary tract surgery can be undertaken in the diabetic with little or no increased risk compared with the nondiabetic with similar physical status. Attempts at laparoscopic cholecystectomy, however, are more likely to require conversion to an open procedure. Whether or not rates of wound infection are increased by diabetes, when they do occur they are likely to be more severe than in the nondiabetic patient. Regardless of whether diabetes is a primary risk factor for complications following surgery or merely a marker for the existence of comorbid conditions that increase risk, the presence of diabetes in a patient requires careful assessment for and correction of conditions that occur frequently in diabetics and may contribute to surgical morbidity.