P-008 - DIABETES IS NOT ASSOCIATED WITH INCREASED IN-HOSPITAL COMPLICATIONS AFTER ELECTIVE ABDOMINAL AORTIC ANEURYSM REPAIR. RESULTS FROM A NATIONAL PROSPECTIVE MULTICENTER-STUDY.

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Wesche J. (Akershus University Hospital ~ Loerenskog ~ Norway) , Nyrønning L.A. (St.Olavs Hospital ~ Trondheim ~ Norway) , Altreuther M.E. (St.Olavs Hospital ~ Trondheim ~ Norway) , Gubberud E.T. (Haukeland University Hospital ~ Bergen ~ Norway) , Fagertun H. (St.Olavs Hospital ~ Trondheim ~ Norway) , Bakken T. (Sykehuset Vestfold ~ Tønsberg ~ Norway) , Helgeland M.T. (Akershus University Hospital ~ Loerenskog ~ Norway) , Loose H. (Oslo University Hospital ~ Oslo ~ Norway) , Kjellsen I.S. (Stavanger University Hospital ~ Stavanger ~ Norway) , Pettersen E.M. (Soerlandet Hospital Kristiansand ~ Kristiansand ~ Norway) , Kiil S. (Vestre Viken Hospital Drammen ~ Drammen ~ Norway) , Lyng C. (Innlandet Hospital Hamar ~ Hamar ~ Norway) , Kjørstad K. (University Hospital of Northern Norway ~ Tromsoe ~ Norway) , Vetrhus M. (Stavanger University Hospital ~ Stavanger ~ Norway) , Jonung T. (Haukeland University Hospital ~ Bergen ~ Norway) , Pedersen G. (Haukeland University Hospital ~ Bergen ~ Norway) , Mattsson E. (Norwegian University of Science and Technology ~ Trondheim ~ Norway) , Hjellestad I.D. (Haukeland University Hospital ~ Bergen ~ Norway)
Introduction:
Patients with Diabetes Mellitus (DM) have a higher rate of cardiovascular and peripheral arterial diseases than the general population (1). There are however conflicting results whether DM patients have a worse outcome after abdominal aortic aneurysm (AAA) treatment with either open surgical repair (OSR) or endovascular aneurysm repair (EVAR) (2-6). Our aim was to investigate the prevalence of DM in patients admitted for elective AAA repair, and compare the in-hospital outcome after AAA treatment in patients with and without DM.
Methods:
A national prospective multicenter study (n= 11) on 896 consenting patients having elective infrarenal AAA repair (OSR or EVAR) was performed during 2018-2020. Glycosylated haemoglobin (HbA1c) was measured in all patients. A DM diagnosis was defined as previously registered diabetes and screening-detected HbA1c ≥ 48 mmol/mol. The main exposure was DM. The primary outcomes were in-hospital mortality, complications, re-interventions and amputations. Length of stay (LOS) was the secondary outcome. Differences between DM and non-DM patients were evaluated using the t-test for continuous variables and the Chi-square or Fisher exact test for categorical variables. Odds ratios (OR), with 95% confidential intervals (CI) for any complication (no, yes), were calculated as estimates of relative risk in unadjusted and adjusted logistic regression models. Adjustments were made for age, gender, body mass index (BMI), smoking status, type of surgery, blood loss, procedural time and comorbidities (coronary artery disease, hypertension, reduced renal function, chronic obstructive lung disease and cerebrovascular disease).
Results:
The overall DM prevalence was 14.7 % (n= 132), of which almost a fourth of the cases (n=32) were detected at inclusion. OSR was performed in 467 patients (52%) and EVAR in 429 (48%). OSR versus EVAR ratio was similar in DM versus non-DM patients. At baseline, DM patients had higher BMI, prevalence of cerebrovascular, coronary artery and peripheral artery disease than non-DM patients. No differences between DM and non-DM patients were observed for age, aortic diameter, smoking status and renal function. The in-hospital mortality was 0.4 % (n=4), whereas the frequency of any complication was 18.9%, of which re-intervention was 5.1% (n=46). The proportion of patients with complications did not differ between those with and without DM (21.9 % vs. 18.3 %, p=0.3). There were no in-hospital amputations, and LOS was similar for patients with DM and those without (5.0 days vs. 5.3 days). There was no significant increase in the risk of in-hospital complications in patients with DM compared to those without DM, neither in the univarible (OR 1.25, 95 % CI 0.70-1.95) nor in the adjusted logistic regression model (OR 1.54, 95 % CI 0.89-2.69). In the adjusted model, a higher risk of in-hospital complications was observed for women, BMI, chronic obstructive lung disease, blood loss at operation and procedural time.
Conclusion:
Diabetes was not associated with impaired in-hospital outcome after elective AAA repair, although half of the cohort was treated with OSR and almost a quarter of all DM cases were previously undiagnosed.
References:
1. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol (2018)17:83. https://doi.org/10.1186/s12933-018-0728-6. 2. De Rango P, Farchioni L, Fiorucci B, Lenti M. Diabetes and abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 214;47:243-61. 3. Avdic T, Franzen S, Zarrouk M, Acosta S, Nilsson P, Gottsater A, Svensson AM, Gudbjørnsdottir S, Eliasson B. Reduced long-term risk of aortic aneurysm and aortic dissection among individuals with type 2 diabetes mellitus: A nationwide observational study. J Am Heart Assoc. 2018, 7;e007618. DOI: 10.1161/JAHA.117. 007618 https://www.ahajournals.org/doi/pdf/10.1161/JAHA.117.007618. 4. Raffort J, Lareyre F, Fabre R, Mallat Z, Pradier C, Bailly L. Nationwide study in France investigating the impact of diabetes on mortality in patients undergoing abdominal aortic aneurysm repair. Scientific Reports (2021):11:19395 https://doi.org./10.1038/s41598-021-98893-x