Diabetes mellitus is associated with short-term postoperative outcomes in patients undergoing vats lobectomy for lung cancer: a 7-year retrospective analysis

Background: Diabetes mellitus (DM) is a prevalent metabolic disorder and a well-recognized perioperative risk factor across non-cardiac surgical populations. However, its correlative association with short-term postoperative complications after video-assisted thoracoscopic surgery (VATS) lobectomy remains insufficiently characterized. This study explores the relationship between DM and postoperative outcomes using a large national inpatient database. Methods: A retrospective cohort study was conducted based on the 2016-2022 Nationwide Inpatient Sample. Adult patients undergoing VATS lobectomy for lung cancer were identified via International Classification of Diseases, 10th Revision coding, and participants were stratified by the presence or absence of DM. Multivariable logistic regression were used to evaluate the correlative links between DM and postoperative complications after adjusting for demographic, comorbid, and hospital-related covariates. Results: A total of 34,398 eligible patients were included in the final cohort, among whom 7,515 (21.84%) had a diagnosis of DM. Diabetic patients were older and had a higher overall comorbidity burden compared with non-diabetic counterparts, accompanied by a higher crude incidence of in-hospital postoperative complications. After multivariable adjustment, DM was associated with elevated odds of acute respiratory insufficiency [odds ratio (OR) 1.177; 95% confidence interval (CI): 1.077 to 1.286; P<0.001], myocardial infarction (OR 1.714; 95% CI: 1.561 to 1.882; P<0.001), delirium (OR 1.509; 95% CI: 1.198 to 1.902; P<0.001), requirement for mechanical ventilation (OR 1.208; 95% CI: 1.033 to 1.412; P=0.02), and supraventricular arrhythmia (OR 1.143; 95% CI: 1.073 to 1.218; P<0.001). An inverse correlation between DM and acute pneumothorax was also observed (OR 0.869; 95% CI: 0.778 to 0.971; P=0.01). Conclusions: This large nationwide observational cohort reveals correlative associations between DM and increased risks of cardiopulmonary and neurological complications following VATS lobectomy for lung cancer. These observational findings provide supportive insights for perioperative risk assessment and optimized metabolic management in diabetic patients undergoing minimally invasive thoracic surgery.