Preoperative diabetes complicates postsurgical recovery but does not amplify readmission risk following pancreatic surgery

Mohammad Hosny Hussein; Eman Ali Toraih; Adin Reisner; Areej Shihabi; Zaid Al-Quaryshi; Jeffrey Borchardt; Emad Kandil

doi:10.21037/gs-21-648

Preoperative diabetes complicates postsurgical recovery but does not amplify readmission risk following pancreatic surgery

Gland Surg. 2022 Apr;11(4):663-676. doi: 10.21037/gs-21-648.

Authors

Mohammad Hosny Hussein¹, Eman Ali Toraih^{1

2}, Adin Reisner³, Areej Shihabi¹, Zaid Al-Quaryshi⁴, Jeffrey Borchardt⁵, Emad Kandil¹

Affiliations

¹ Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
² Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
³ Tulane University, School of Medicine, New Orleans, LA, USA.
⁴ Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
⁵ Department of Anesthesiology, Tulane University School of Medicine, New Orleans, LA, USA.

Abstract

Background: Diabetes is a significant and prevalent medical condition associated with increased comorbidities, longer hospital length of stay, and higher healthcare costs. We aimed to assess the association between diabetes mellitus and postoperative outcomes following pancreatic surgeries.

Methods: Records for patients with major elective pancreatic surgeries were retrieved retrospectively from the Nationwide Readmission Database (2010-2014). Association of diabetic status with postoperative complications, in-hospital mortality, length of stay (LOS), readmission rate, and hospital costs were investigated. Logistic regression and decision tree analyses were employed to predict adverse outcomes.

Results: A total of 8,401 patients who had pancreatic surgery were included. They were categorized according to their diabetic diagnosis. Results showed that diabetic patients had a higher risk of postoperative complications compared to non-diabetics (OR: 1.27, 95% CI: 1.08-1.49, P=0.003). Bleeding and renal complications were the most significant. Uncontrolled diabetes significantly required a longer hospital stay (9.17±4.28 vs. 8.03±4.96 days, P=0.001), and incurred higher hospital costs ($34,171.04±$20,846.61 vs. $28,182.21±$24,070.27, P=0.001). After multivariate regression, no association was found with in-hospital mortality or readmission rates; however, diabetic patients' length of stay during readmission was increased at 30- and 90-day readmissions (P=0.004 and 0.007, respectively).

Conclusions: Among patients who underwent pancreatic surgery, those with diabetes had a higher rate of postoperative complications compared to non-diabetics. Additionally, diabetic patients had higher hospital charges and costs during primary admission. Initial analysis of patients with diabetes showed they had higher rates of 30- and 90-day readmissions, though this did not maintain significance after regression analysis. Exploring the mechanisms underlying this finding would aid in preventing postoperative complications and reducing healthcare costs.

Keywords: Pancreatectomy; cost; mortality; national database; readmission.