Effect of Diabetes Mellitus on Postoperative Complications following Intradural Skull Base Surgery

Introduction: Diabetes mellitus (DM) is a well-known risk factor for significant postoperative complications across various surgical specialties. As the prevalence rates of DM continue to rise in the United States, its impact on postoperative outcomes following intradural skull base surgery (SBS) remains limited. Therefore, the aim of this study is to determine the effect of DM on the postoperative outcomes of patients undergoing intradural resections of skull base lesions.

Study Design: Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Methods: The 2005–2018 ACS-NSQIP database was queried for 30-day postoperative outcomes of patients undergoing intradural resection of the skull base based on Current procedural terminology (CPT) codes. Patients were stratified into two cohorts based on the presence of DM. Univariate analyses were performed to account for baseline differences between cohorts. Multivariate logistic regression was performed to identify the independent effects of DM on postoperative outcomes.

Results: A total of 1,728 patients were included in the analysis, of which 12.0% had a diagnosis of DM. Patients with DM were significantly older (51.9 ± 14.8 years versus 60.8 ± 11.1 years, p < 0.001) with a higher body mass index (BMI) (29.2 ± 7.8 versus 32.4 ± 8.0, p < 0.001). Patients with DM were also found to have significantly higher rates of dyspnea (p = 0.018), obesity (p < 0.001), hypertension requiring medications (p < 0.001), disseminated cancer (p = 0.010), systemic sepsis (p = 0.034), and chronic steroid use (p = 0.008). A greater proportion of DM patients experienced postoperative complications including pneumonia (p = 0.027), urinary tract infection (UTI) (p = 0.003), CVA (p = 0.048), bleeding requiring transfusion (p = 0.001), septic shock (p = 0.037), and renal insufficiency (p = 0.004). Multivariate analysis revealed that DM patients were at significantly increased risk for postoperative UTI (OR = 3.530, p = 0.023), bleeding (OR = 1.899, p = 0.020), and septic shock (OR = 11.751, p = 0.015).

Conclusion: Patients with DM are at heightened risk for complications following intradural SBS including UTI, bleeding, and septic shock. Surgeons should consider careful preoperative counseling and strict glycemic peri-operative monitoring for DM patients prior to surgery to minimize post-operative complications.

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Artikel online veröffentlicht:
15. Februar 2022