TITLE:
Morbidity and Mortality during Anaesthesia in Patients with versus without Diabetes: Single-Centre Cohort Study
AUTHORS:
Noelly Mukuna, Wilfrid Mbombo, Joseph Nsiala, Aliocha Nkodila, Alphonse Mosolo, Freddy Mbuyi, Jonathan Kukila, Paul Kambala, Rémy Kashala, Chris Nsitwavibidila, Patrick Kobo, Dan Kankonde, Gracias Likinda, Jean Claude Mubenga, Khazi Anga, Lionel Diyamona, Berthe Barhayiga
KEYWORDS:
Anaesthesia, Diabetes, Morbidity, Mortality, Perioperative
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.14 No.3,
March
27,
2024
ABSTRACT: Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94]; p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.