The effect of diabetes mellitus on perioperative outcomes following colorectal resections: a national cohort study

Gysling, Savannah; Lewis-Lloyd, Christopher A; Lobo, Dileep N; Crooks, Colin J; Humes, David J

Abstract

Background: Diabetes mellitus is a significant modulator of postoperative outcomes and is an important risk factor in the patient selection process. We aimed to investigate the effect of diabetes mellitus and use of insulin on outcomes following colorectal resections using a national cohort.
Methods: Adults with a recorded colorectal resection in England between 2010 and 2020 were identified from Hospital Episode Statistics data linked to the Clinical Practice Research Database. The primary outcome was 90-day mortality. Secondary outcomes included hospital length-of-stay (LOS) and readmission within 90 days.
Results: Of the 106,139 (52,875, 49.8% male) patients included, diabetes was prevalent in 10,931 (10.3%), 2145 (19.6%) of whom had a record of use of insulin. Unadjusted 90-day mortality risk was 5.7%, with an increased adjusted hazard ratio (aHR) for people with diabetes (aHR 1.28, 95% CI 1.19–1.37, P<0.001). This risk was higher in both people with diabetes using insulin (aHR 1.51, 95% CI 1.31–1.74, P<0.001) and not using insulin (aHR 1.22, 95% CI 1.13–1.33, P<0.001), compared with those without diabetes. 90-day readmission occurred in 20,542 (19.4%) patients and this was more likely in those with diabetes (aHR 1.23, 95% CI 1.18–1.29, P<0.001). Median (IQR) LOS was 8 (5-15) days and was higher in people with diabetes (adjusted time ratio 1.10, 95% CI 1.08–1.11, P<0.001).
Conclusions: People with diabetes undergoing colorectal resections are at a higher risk of 90-day mortality, prolonged LOS and 90-day readmission, with use of insulin associated with additional risk.

Citation

Gysling, S., Lewis-Lloyd, C. A., Lobo, D. N., Crooks, C. J., & Humes, D. J. (2024). The effect of diabetes mellitus on perioperative outcomes following colorectal resections: a national cohort study. British Journal of Anaesthesia, 133(1), 67-76

• Journal Article Type: Article
• Acceptance Date: Apr 2, 2024
• Online Publication Date: May 16, 2024
• Publication Date: 2024-07
• Deposit Date: Apr 5, 2024
• Publicly Available Date: May 17, 2025
• Journal: British Journal of Anaesthesia
• Print ISSN: 0007-0912
• Electronic ISSN: 1471-6771
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 133
• Issue: 1
• Pages: 67-76
• Keywords: cohort study; colorectal surgery; complications; diabetes mellitus; insulin; mortality; outcomes
• Public URL: https://nottingham-repository.worktribe.com/output/33292776