Diabetes Mellitus in Patients Presenting with Adhesive Small Bowel Obstruction: Delaying Surgical Intervention Results in Worse Outcomes
Karamanos E, Dulchavsky S, Beale E, Inaba K, and Demetriades D. Diabetes mellitus in patients presenting with adhesive small bowel obstruction: Delaying surgical intervention results in worse outcomes. World J Surg 2016; 40(4):863-869.
World journal of surgery
INTRODUCTION: The impact of diabetes mellitus (DM) on outcomes in patients undergoing emergency laparotomy for adhesive small bowel obstruction (ASBO) remains unknown.
METHODS: Low-risk (ASA class of I and II) patients requiring emergency operation for ASBO were identified using the ACS NSQIP database. Propensity score matching was used to match patients with DM to those without DM in a ratio of 1:3. Mortality, infectious complications, acute renal failure (ARF), and myocardial infarction (MI) were compared between the two groups. The impact of delaying OR ≥ 24 h was also analyzed in the two groups.
RESULTS: A total of 1,608 patients were matched, 402 with DM and 1,204 without DM. Overall, patients with DM were significantly more likely to develop infections, ARF and MI. Diabetes had no negative impact on outcomes if the operation was performed within 24 h of admission. However, delaying surgery >24, significantly increased infections, ARF and MI.
CONCLUSIONS: DM in low-risk patients has no negative impact on outcomes in patients undergoing surgery for ASBO within 24 h. However, delaying surgery >24 h resulted in worse outcomes.
Medical Subject Headings
Acute Kidney Injury; Aged; Aged, 80 and over; Comorbidity; Databases, Factual; Diabetes Mellitus; Emergencies; Female; Hospitalization; Humans; Intestinal Obstruction; Intestine, Small; Laparotomy; Logistic Models; Male; Middle Aged; Mortality; Myocardial Infarction; Pneumonia; Postoperative Complications; Propensity Score; Retrospective Studies; Surgical Wound Dehiscence; Surgical Wound Infection; Time-to-Treatment; Tissue Adhesions; Treatment Outcome