School of Medicine and Health Sciences Poster Presentations

Title

Perioperative Complications Associated with Diabetes Mellitus in Patients Undergoing Tonsillectomies with Adenoidectomies: Insulin-Dependence Makes a Difference.

Document Type

Poster

Abstract Category

Quality Improvement

Keywords

Tonsillectomy, Diabetes

Publication Date

Spring 5-1-2019

Abstract

Introduction: Over 1 million Adenotonsillectomies (AT) are performed each year in the United States, to treat sleep disordered breathing, obstructive sleep apnea, and chronic adenotonsillitis. Although T&A is a common and safely performed surgery, it is not without significant risk of complications (bleeding, acute pain, dehydration, and pulmonary edema). These adverse events tend to be more prevalent in adults with comorbidities in comparison to adults without them.Since patients with diabetes mellitus (DM) comprise a significant population that undergoes AT, determining the correlation between Diabetes Mellitus and and post-operative complications could enable physicians to take preemptive cautionary measures, counsel patients on outcomes and expectations, or determine whether the patient is a better candidate for a non-invasive intervention, in order to decrease complications and health care costs. Methods: The ACS-NSQIP database was queried for patients who had undergone tonsillectomies with adenoidectomies simultaneously from 2005 to 2016. These patients were then stratified into three cohorts based on their diabetes mellitus status for comparison in patient characteristics and to analyze the impact of DM on the risk for surgical complications: non-diabetics (Non-DM), non-insulin dependent DM, and insulin dependent DM. Multivariate and univariate analysis was performed to determine the risk of post-operative complications for DM patients. Results: On multivariate analyses, diabetic patients, as a whole, were at an increased risk for three complications. Diabetes mellitus was a significant independent risk factor for systemic sepsis, extended length of stay of at least five days, and unplanned readmission. However, IDDM patients had a far greater independent risk of complications after the procedure. Irrespective of the patient's demographics or other preoperative variables, it was found that IDDM independently increases the possibility of developing organ/space SSI, pneumonia, unplanned Intubation, deep venous thromboembolism (DVT), systemic sepsis, greater length of hospital stay, and readmission. Discussion: The increased risk of post-AT surgical complications in IDDM patients stems from poor glucose control, and post-operative complications can arise from both hyperglycemia and hypoglycemia. Surgical procedures, such as AT, can induce hyperglycemia, which has been a known risk factor for postoperative sepsis, endothelial dysfunction, cerebral ischemia, and impaired wound healing. This study urges preoperative counseling and glycemic index management for IDDM patients. Further research should investigate optimization of care before the surgical procedure, difference in management between IDDM and NIDDM patients to determine the specific cause of increased complication rate in IDDM patients, and the benefits of additional inpatient care

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Presented at Research Days 2019.

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Perioperative Complications Associated with Diabetes Mellitus in Patients Undergoing Tonsillectomies with Adenoidectomies: Insulin-Dependence Makes a Difference.

Introduction: Over 1 million Adenotonsillectomies (AT) are performed each year in the United States, to treat sleep disordered breathing, obstructive sleep apnea, and chronic adenotonsillitis. Although T&A is a common and safely performed surgery, it is not without significant risk of complications (bleeding, acute pain, dehydration, and pulmonary edema). These adverse events tend to be more prevalent in adults with comorbidities in comparison to adults without them.Since patients with diabetes mellitus (DM) comprise a significant population that undergoes AT, determining the correlation between Diabetes Mellitus and and post-operative complications could enable physicians to take preemptive cautionary measures, counsel patients on outcomes and expectations, or determine whether the patient is a better candidate for a non-invasive intervention, in order to decrease complications and health care costs. Methods: The ACS-NSQIP database was queried for patients who had undergone tonsillectomies with adenoidectomies simultaneously from 2005 to 2016. These patients were then stratified into three cohorts based on their diabetes mellitus status for comparison in patient characteristics and to analyze the impact of DM on the risk for surgical complications: non-diabetics (Non-DM), non-insulin dependent DM, and insulin dependent DM. Multivariate and univariate analysis was performed to determine the risk of post-operative complications for DM patients. Results: On multivariate analyses, diabetic patients, as a whole, were at an increased risk for three complications. Diabetes mellitus was a significant independent risk factor for systemic sepsis, extended length of stay of at least five days, and unplanned readmission. However, IDDM patients had a far greater independent risk of complications after the procedure. Irrespective of the patient's demographics or other preoperative variables, it was found that IDDM independently increases the possibility of developing organ/space SSI, pneumonia, unplanned Intubation, deep venous thromboembolism (DVT), systemic sepsis, greater length of hospital stay, and readmission. Discussion: The increased risk of post-AT surgical complications in IDDM patients stems from poor glucose control, and post-operative complications can arise from both hyperglycemia and hypoglycemia. Surgical procedures, such as AT, can induce hyperglycemia, which has been a known risk factor for postoperative sepsis, endothelial dysfunction, cerebral ischemia, and impaired wound healing. This study urges preoperative counseling and glycemic index management for IDDM patients. Further research should investigate optimization of care before the surgical procedure, difference in management between IDDM and NIDDM patients to determine the specific cause of increased complication rate in IDDM patients, and the benefits of additional inpatient care