Patients with diabetes who undergo surgical resection for nonmetastatic colon cancer are at a higher risk of dying within 30 days of surgery than those patients without diabetes. Managing anemia and sepsis are 2 ways medical clinicians can help reduce this mortality risk, according to a study published in the journal Diseases of the Colon and Rectum.
The aim of this retrospective cohort study was to assess potential variables that affect the 30-day mortality rate of patients with diabetes after surgery for colon cancer. Data for this study came from the 2013 to 2015 American College of Surgeons National Surgical Quality Improvement Program Participant Use File and Targeted Colectomy File. Patients were grouped based on diabetic status, and records for all-cause 30-day mortality were assessed. Potential mediators were grouped into treatment-related variables, comorbidities, behavior-related variables, surgical complications, and biomarker results.
Of the 26,060 patients included in this study, 18.8% were diagnosed with diabetes requiring insulin or other antidiabetic agents. Compared with patients who did not have diabetes, patients with diabetes were more likely to be older Hispanic or black men with comorbid conditions, elevated adverse biomarkers, and surgical complications. The 30-day mortality rate was higher in patients with diabetes than for those without (2.0% vs 1.3%; P <.001), and after adjusting for age, patients with diabetes were 1.37 times more likely to die post-surgery than patients without diabetes.
The comorbidity variables associated with diabetes and 30-day mortality were functional status (P <.0001), congestive heart failure (P <.0001), renal failure (P =.0449), and chronic obstructive pulmonary disease (P =.0059). The behavior-related variable that was associated with diabetes and 30-day mortality was smoking (P =.0062), and the biomarker variables associated with diabetes and 30-day mortality were preoperative hematocrit levels (P <.0001) and BUN:creatinine ratio (P =.0320).
The mediators associated with diabetes and 30-day mortality were anemia (33.7% of the effect; P =.0001) and sepsis (15.2% of the effect; P =.001).
Limitations of this study included the potential for significant confounding variables that the investigators did not assess because of the retrospective nature of the data, the lack of generalizability due to the data coming from only large hospitals associated with the National Surgical Quality Improvement Program, and not differentiating between type of diabetes or length of time since diabetes diagnosis.
The researchers concluded that “better management and prevention of anemia and sepsis among patients with diabetes mellitus may reduce their increased risk of death after colon cancer resection.”
Schootman M, Jeffe DB, Ratnapradipa KL, Eberth JM, Davidson NO. Increased 30-Day Mortality Risk in Patients With Diabetes Mellitus After Colon Cancer Surgery: A Mediation Analysis. Dis Colon Rectum. 2020;63(3):290-299.