Diabetes as a known risk factor for a number of chronic illnessess. However, there is less research examining whether diabetes is associated with poorer outcomes in the surgical treatment of oesophageal cancer. The main objective of our study is to determine how diabetes is associated with postoperative outcomes dealing with surgical and medical complications in various oesophagectomy procedures.
Data for the ACS-NSQIP datasets (2016-2018) were including demographics, pre-existing comorbidities, intraoperative variables, and outcomes affecting morbidity and mortality. Data used in the current analyses were extracted from all oesophagectomies performed for resection of malignancy identified in the 2016–2018 ACS-NSQIP datasets. CPT codes used were: 1) Open procedures (43107, 43108, 43112, 43113, 43116, 43117, 43118, 43121, 43122, and 43123) and 2) Hybrid procedures (43186, 43287, and 43288).
Logistic regression models were used to examine associations between diabetic status and the various adverse outcomes. These analyses were adjusted for sex, race, age group, operation year, CPT code, body mass index (BMI), smoking, congestive heart failure, use of antihypertensives, renal failure, and dyspnoea.
2,538 oesophagectomies were identified. Majority (2,194, 86.45%) underwent an open procedure and (344, 13.55%) had hybrid procedures. 177 insulin-dependent diabetics and 320 (12.61%) non–insulin-dependent diabetics. 84.14%)were male, 77.74% were Caucasian. 89.48% of the patients were between 50 and 79 years of age. 40.27% experienced postoperative complications. Medical Complications (OR: 1.7, p-value: 0.002), Surgical Complications (OR: 1.9, p-value: <0.001), Wound Complications (OR: 2.9, p-value: <0.001) and Anastomotic Leaks (OR: 2.4, p-value: <0.001).
Insulin-dependent diabetics have double the risk of all major complications compared to non-diabetics. Subgroup analysis shows that when considering approach of surgery and diabetes status, the risk of complications further doubles for hybrid procedures when compared to open procedures (the gold standard).