Declining perioperative cardiac event rates not seen in patients with diabetes
medwireNews: The rate of perioperative cardiovascular events has increased over time in patients with diabetes undergoing noncardiac surgery, a trend that does not reflect declines recently observed among US inpatients for some specific cardiovascular events.
The study, which included US National Inpatient Sample data on 10,581,621 hospitalizations for major noncardiac surgery between 2004 and 2013, showed that the rate of perioperative major adverse cardiovascular and cerebrovascular events (MACCEs) was significantly higher in patients with diabetes than in those without diabetes, at 3.3% versus 2.8%.
This difference corresponds to 25,000 excess perioperative events annually among patients with diabetes, Jonathan Newman and colleagues, from New York University School of Medicine in the USA, report in Diabetes Care.
The patients undergoing surgery were all aged 45 years and older and approximately 23% had diabetes overall. However, this proportion increased significantly over time, from 20.3% in 2004 to 25.4% in 2013.
In patients both with and without diabetes, the crude rate of perioperative MACCEs, namely in-hospital all-cause mortality, acute myocardial infarction, or acute ischemic stroke, decreased over time by 222 and 730 cases per 100,000 surgeries, respectively.
But the odds of perioperative MACCEs increased by 6% for patients with diabetes whereas it fell by 8% for those without diabetes, after adjustment for multiple potential confounders.
When the researchers analyzed data for the individual endpoints they found that the temporal trends were all less favorable for patients with diabetes than for those without.
Specifically, the adjusted likelihood of perioperative mortality and acute myocardial infarction declined by 14% and 7%, respectively, over time in patients with diabetes but fell by a significantly greater 24% and 16%, respectively, in those with no diabetes.
The adjusted likelihood for perioperative stroke increased by 96% in patients with diabetes and by a significantly lower 73% in those without it.
Newman and team point out that, overall, diabetes was not associated with a significantly increased risk for perioperative MACCEs after multivariable adjustment, but uncontrolled diabetes was, at an adjusted odds ratio of 1.41 compared with patients without diabetes.
“This indicates that covariates/confounders may drive excess perioperative MACCEs in patients with well-controlled [diabetes], but uncontrolled [diabetes] is an independent risk factor for perioperative events,” they write.
The authors conclude: “Our findings suggest that a substantial unmet need exists for strategies to reduce the risk of perioperative cardiovascular events among patients with [diabetes].”
By Laura Cowen
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