Newman JD, et al. - This trial examined if patients with diabetes mellitus (DM) are part of the temporal declines seen in the frequency of perioperative major adverse cardiovascular and cerebrovascular events (MACCEs). It was determined that perioperative MACCEs were more common among patients with DM vs without DM in an analysis of >10.5 million noncardiac surgeries from a large U.S. hospital admission database. A rise was noted in perioperative MACCEs over time and individual endpoints appeared to be less favorable for patients with DM. Strategies in order to reduce the risk of perioperative cardiovascular events among patients with DM are still needed.

Methods

• Using the U.S. National Inpatient Sample, candidates ≥45 years of age who underwent noncardiac surgery from January 2004 to December 2013 were examined.
• DM was identified via ICD-9 diagnosis codes.
• Assessment of the perioperative MACCEs (in-hospital all-cause mortality, acute myocardial infarction, or acute ischemic stroke) by DM status was performed.

Results

• A total of 10,581,621 hospitalizations were analyzed for major noncardiac surgery, and DM was noted in ∼23% of surgeries, but that increased over time (P for trend < 0.001).
• MACCEs were reported by subjects with DM in 3.3% of surgeries vs 2.8% of surgeries for patients without DM (P < 0.001).
• After multivariable adjustment, the odds of perioperative MACCEs increased by 6% (95% CI 2-9%) from 2004 to 2013 for DM patients, vs an 8% decrease (95% CI -10% to -6%) for patients without DM (P for interaction < 0.001).