The American Association of Clinical Endocrinologists 21st Annual Scientific and Clinical Congress:

Diabetic Complications Lead to Increased Length of Stay Following Elective Surgeries

While the correlation between length of stay following elective surgical procedures and higher health care costs is not new, researchers from Vanderbilt University Medical Center in Nashville, Tennessee, concluded that diabetic patients undergoing such procedures have higher rates of complications due to the vascular conditions and risks of infections that often accompany diabetes.  This increases their length of stay.1

M. Kathleen Figaro, MD, et al, evaluated data from the 2008 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (29,589 patients with diabetes and 793,827 patients without diabetes), specifically looking at comorbidities and perioperative complications as they related to length of stay for diabetic patients in 13 procedures.

Elective operations evaluated included thyroidectomy, hysterectomy, mastectomy, colectomy, cholecystectomy, amputations, fracture repairs, and total joint replacements, among others.

Across the board, results showed variations between the 2 patient cohorts. Patients with diabetes were more likely to have hypertension prior to surgery (72.7% vs 46.1%) and had more chronic conditions upon admission (mean of 7.6 vs 3.6 diagnoses).

Significant differences in patients with diabetes versus those without were seen in mortality rate (1.42% vs 0.93%), myocardial infarction (1.6% vs 0.59%), pneumonia (2.88% vs 0.32%), and acute kidney injury (11.2% vs 2.53%) (p >0.0001 for all).

Dr. Figaro and colleagues determined that, out of the 13 evaluated elective procedures, results from 11 procedures showed increased cost per patient in the diabetes group.

For the diabetes group, hospital length of stay (mean, 9.08 vs 4.76 days; p < 0.0001) and cost per patient ($19,547 vs $15,873; p < 0.0001) were also higher. Overall, investigators concluded that diabetes patients incurred greater rates of complications, had higher hospital costs, and had longer lengths of stay than non-diabetes patients following 11 major elective procedures, either common or uncommon.1 In light of these findings, Dr. Figaro stressed the importance of preoperative opportunities for health care professionals to control blood glucose levels more effectively in an effort to decrease elective surgical complications in diabetic patients.

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