Preoperative opportunity to control blood glucoses

Patients with diabetes mellitus experience significantly higher rates of surgical and systemic complications, higher mortality and increased length of stay during hospitalization following 11 major elective procedures, according to research presented today at the American Association of Clinical Endocrinologists (AACE) 21st Annual Meeting & Clinical Congress in Philadelphia.

“However, for elective procedures, there is a preoperative opportunity for healthcare professionals to control blood glucoses more effectively.”

The study compared the length of stay in hospitals after select major elective procedures between patients with diabetes, those with complicated diabetes and those without diabetes. The procedures included thyroidectomy, hysterectomy, mastectomy, amputations, fracture repairs, total joint replacements and others that are scheduled in advance. Results showed significant differences between those with diabetes and those without in terms of mortality rate, pneumonia and acute kidney injury. Data also showed significant increases in length of hospital stay, as well as higher hospital costs for diabetes patients following all elective procedures except mastectomy and amputations.

"The fact that surgical procedures cost more for diabetic patients is not new information," said Dr. Kathleen Figaro, lead researcher on the study. "However, for elective procedures, there is a preoperative opportunity for healthcare professionals to control blood glucoses more effectively." Other studies suggest that with improved glucose control, there is potential to decrease complications, lengths of stay and costs following elective procedures. Dr. Figaro added, "This is a unique learning opportunity for patients with diabetes where they can focus on improving their diabetes control to lower their chance of surgical complications."

Dr. Figaro explained that diabetes alone was not the predictor of longer hospital stays and higher costs. Rather, the complications that accompany diabetes, such as vascular conditions and higher risks of infection, were associated with the higher rates of surgical complications. The research showed that within the two groups of patients with diabetes, those with complicated diabetes did worse in several areas measured. She plans to do additional research to further clarify the relationship between complications of diabetes and surgical complications.

However, the immediate impact of this information could be substantial. The study authors conclude: "National policy initiatives will soon bundle payments for many elective procedures. This [length of stay costs] will likely compel healthcare systems to reevaluate their protocols and improve pre-operative control of diabetes in order to lower the costs of elective surgery."

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