背景:目的是调查已知和未诊断的糖尿病(DM)的总患病率,以及糖尿病与择期手术后围手术期并发症的关系,肾下,开放手术(OSR)或血管内(EVAR),腹主动脉瘤(AAA)修复。
方法:在这项挪威前瞻性多中心研究中,从2017年11月至2020年12月,877例患者通过HbA1c测量进行了术前DM筛查。糖尿病定义为筛查检测到HbA1c≥48mmol/mol(6.5%)或先前诊断为糖尿病。DM与住院并发症的关系,逗留时间,使用调整和未调整的逻辑回归模型评估30日死亡率.
结果:DM的总患病率为15%(95%CI13%,17%),其中25%的DM病例(95%CI18%,33%)在入院接受AAA手术后未被诊断。OSR与EVAR的比率为52%与48%,在DM患者中分布相似,EVAR与OSR组的已知和未诊断DM的患病率没有差异。总30天死亡率为0.6%(5/877)。58例(7%)患者发生了66例器官相关并发症。DM与院内器官相关并发症的高风险无统计学意义(OR1.23,95%CI0.57,2.39,p=0.57),手术相关并发症(OR1.48,95%CI0.79,2.63,p=0.20),30天死亡率(p=0.09)或住院时间(HR1.06,95%CI0.88,1.28,p=0.54)。根据事后分析,新诊断DM患者(n=32)的器官相关并发症发生率高于非DM患者(OR4.92;95%CI1.53,14.3,p=0.005).
结论:在进行AAA手术时,所有DM病例中有25%未被诊断。根据事后分析,未确诊的DM似乎与AAA手术后器官相关并发症的风险增加相关.这项研究建议在AAA患者中进行普遍的DM筛查,以减少未诊断的DM患者的数量,并改善该人群的前瞻性糖尿病护理。事后分析的结果应在未来的研究中得到证实。
BACKGROUND: The aim was to investigate the total prevalence of known and undiagnosed diabetes mellitus (DM), and the association of DM with perioperative complications following elective, infrarenal, open surgical (OSR) or endovascular (EVAR), Abdominal Aortic Aneurysm (AAA) repair.
METHODS: In this Norwegian prospective multicentre study, 877 patients underwent preoperative screening for DM by HbA1c measurements from November 2017 to December 2020. Diabetes was defined as screening detected HbA1c ≥ 48 mmol/mol (6.5%) or previously diagnosed diabetes. The association of DM with in-hospital complications, length of stay, and 30-day mortality rate were evaluated using adjusted and unadjusted logistic regression models.
RESULTS: The total prevalence of DM was 15% (95% CI 13%,17%), of which 25% of the DM cases (95% CI 18%,33%) were undiagnosed upon admission for AAA surgery. The OSR to EVAR ratio was 52% versus 48%, with similar distribution among DM patients, and no differences in the prevalence of known and undiagnosed DM in the EVAR versus the OSR group. Total 30-day mortality rate was 0.6% (5/877). Sixty-six organ-related complications occurred in 58 (7%) of the patients. DM was not statistically significantly associated with a higher risk of in-hospital organ-related complications (OR 1.23, 95% CI 0.57,2.39, p = 0.57), procedure-related complications (OR 1.48, 95% CI 0.79,2.63, p = 0.20), 30-day mortality (p = 0.09) or length of stay (HR 1.06, 95% CI 0.88,1.28, p = 0.54). According to post-hoc-analyses, organ-related complications were more frequent in patients with newly diagnosed DM (n = 32) than in non-DM patients (OR 4.92; 95% CI 1.53,14.3, p = 0.005).
CONCLUSIONS: Twenty-five percent of all DM cases were undiagnosed at the time of AAA surgery. Based on post-hoc analyses, undiagnosed DM seems to be associated with an increased risk of organ related complications following AAA surgery. This study suggests universal DM screening in AAA patients to reduce the number of DM patients being undiagnosed and to improve proactive diabetes care in this population. The results from post-hoc analyses should be confirmed in future studies.