Key result
Diabetes affects ~15% of elective AAA repair patients, with one quarter previously undiagnosed.
Why the study?
The total prevalence of known and undiagnosed diabetes mellitus and its association with perioperative complications following elective infrarenal AAA repair were not well characterized.
Cohort (n=877)
Yes
A high proportion (25%) of diabetes cases in patients undergoing elective AAA repair are undiagnosed, and while overall diabetes was not significantly associated with 30-day complications, undiagnosed diabetes may increase the risk of organ-related complications, supporting universal screening in this population.
May support preoperative diabetes screening in elective AAA repair; hypothesis-generating for perioperative risks.
BACKGROUND: The aim was to investigate the total prevalence of known and undiagnosed diabetes mellitus (DM), and the association of DM with perioperative complications following elective, infrarenal, open surgical (OSR) or endovascular (EVAR), Abdominal Aortic Aneurysm (AAA) repair. METHODS: ≥ 48 mmol/mol (6.5%) or previously diagnosed diabetes. The association of DM with in-hospital complications, length of stay, and 30-day mortality rate were evaluated using adjusted and unadjusted logistic regression models. RESULTS: The total prevalence of DM was 15% (95% CI 13%,17%), of which 25% of the DM cases (95% CI 18%,33%) were undiagnosed upon admission for AAA surgery. The OSR to EVAR ratio was 52% versus 48%, with similar distribution among DM patients, and no differences in the prevalence of known and undiagnosed DM in the EVAR versus the OSR group. Total 30-day mortality rate was 0.6% (5/877). Sixty-six organ-related complications occurred in 58 (7%) of the patients. DM was not statistically significantly associated with a higher risk of in-hospital organ-related complications (OR 1.23, 95% CI 0.57,2.39, p = 0.57), procedure-related complications (OR 1.48, 95% CI 0.79,2.63, p = 0.20), 30-day mortality (p = 0.09) or length of stay (HR 1.06, 95% CI 0.88,1.28, p = 0.54). According to post-hoc-analyses, organ-related complications were more frequent in patients with newly diagnosed DM (n = 32) than in non-DM patients (OR 4.92; 95% CI 1.53,14.3, p = 0.005). CONCLUSION: Twenty-five percent of all DM cases were undiagnosed at the time of AAA surgery. Based on post-hoc analyses, undiagnosed DM seems to be associated with an increased risk of organ related complications following AAA surgery. This study suggests universal DM screening in AAA patients to reduce the number of DM patients being undiagnosed and to improve proactive diabetes care in this population. The results from post-hoc analyses should be confirmed in future studies.
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Wesche et al. (2024) conducted a cohort in Abdominal Aortic Aneurysm (n=877). Diabetes mellitus vs. No diabetes was evaluated on Prevalence of previously diagnosed and undiagnosed diabetes mellitus (95% CI 13%,17%). In patients undergoing elective infrarenal abdominal aortic aneurysm repair, the total prevalence of diabetes was 15%, with 25% of these cases being undiagnosed at the time of surgery.
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