Skip to main content
Top
Published in: Langenbeck's Archives of Surgery 2/2017

01-03-2017 | ORIGINAL ARTICLE

Diabetes as a risk factor in patients undergoing groin hernia surgery

Authors: Gustaf Hellspong, Ulf Gunnarsson, Ursula Dahlstrand, Gabriel Sandblom

Published in: Langenbeck's Archives of Surgery | Issue 2/2017

Login to get access

Abstract

Background

Diabetes is a known risk factor for early postoperative complications. Even so, the incidence of acute postoperative complications following routine hernia surgery is seldom described, and the risk for reoperation for recurrence has hardly been studied. Our aim was to explore if diabetes is a significant risk factor for complications after inguinal hernia surgery.

Methods

All inguinal hernia repairs registered in the Swedish Hernia Register between 2002 and 2011 were identified. Information on comorbidity and postoperative complications was obtained through cross-referencing with the National Patient Register at the National Board of Health and Welfare. Complicated diabetes was defined as diabetes with secondary manifestations (corresponding to aDCSI >0). The hazards for postoperative complications and reoperation for recurrence after the index hernia operation were calculated.

Results

Altogether 162,713 inguinal hernia repairs on 143,041 patients were registered. Of these, the number of patients with diabetes was 4816 (3.4 %), including 1123 (0.8 %) patients with complicated diabetes (aDCSI > 0). A significantly increased risk for postoperative complications was observed up to 30 days after hernia surgery when adjusted for gender, age, BMI, history of liver disease, kidney disease or HIV/AIDS, type of hernia and surgical method (odds ratio 1.35, 95 % confidence interval 1.14–1.60). No significantly increased risk for reoperation up until December 31, 2011, was observed in either patient group.

Conclusion

Diabetes seems to increase the risk for postoperative complications within 30 days of inguinal hernia surgery, especially for complicated diabetes. Diabetes does not seem to increase the long-term risk for reoperation for recurrence.
Literature
1.
go back to reference Jackson RS et al (2012) Hyperglycemia is associated with increased risk of morbidity and mortality after colectomy for cancer. J Am Coll Surg 214(1):68–80CrossRefPubMed Jackson RS et al (2012) Hyperglycemia is associated with increased risk of morbidity and mortality after colectomy for cancer. J Am Coll Surg 214(1):68–80CrossRefPubMed
2.
go back to reference Vilar-Compte D et al (2008) Hyperglycemia as a risk factor for surgical site infections in patients undergoing mastectomy. Am J Infect Control 36(3):192–198CrossRefPubMed Vilar-Compte D et al (2008) Hyperglycemia as a risk factor for surgical site infections in patients undergoing mastectomy. Am J Infect Control 36(3):192–198CrossRefPubMed
3.
go back to reference Ramos M et al (2008) Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg 248(4):585–591PubMed Ramos M et al (2008) Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg 248(4):585–591PubMed
4.
go back to reference Malmstedt J et al (2006) Influence of perioperative blood glucose levels on outcome after infrainguinal bypass surgery in patients with diabetes. Br J Surg 93(11):1360–1367CrossRefPubMed Malmstedt J et al (2006) Influence of perioperative blood glucose levels on outcome after infrainguinal bypass surgery in patients with diabetes. Br J Surg 93(11):1360–1367CrossRefPubMed
5.
go back to reference Golden SH et al (1999) Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care 22(9):1408–1414CrossRefPubMed Golden SH et al (1999) Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care 22(9):1408–1414CrossRefPubMed
9.
go back to reference Ludvigsson JF et al (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24(11):659–667CrossRefPubMedPubMedCentral Ludvigsson JF et al (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24(11):659–667CrossRefPubMedPubMedCentral
11.
go back to reference Chang HY et al (2012) Validating the adapted Diabetes Complications Severity Index in claims data. Am J Manag Care 18(11):721–726PubMed Chang HY et al (2012) Validating the adapted Diabetes Complications Severity Index in claims data. Am J Manag Care 18(11):721–726PubMed
12.
go back to reference The National Swedish Diabetes Register Annual Report (2012) The National Swedish Diabetes Register Annual Report (2012)
13.
go back to reference Kolluru GK, Bir SC, Kevil CG (2012) Endothelial dysfunction and diabetes: effects on angiogenesis, vascular remodeling, and wound healing. Int J Vasc Med 2012:918267PubMedPubMedCentral Kolluru GK, Bir SC, Kevil CG (2012) Endothelial dysfunction and diabetes: effects on angiogenesis, vascular remodeling, and wound healing. Int J Vasc Med 2012:918267PubMedPubMedCentral
14.
go back to reference Lerman OZ et al (2003) Cellular dysfunction in the diabetic fibroblast: impairment in migration, vascular endothelial growth factor production, and response to hypoxia. Am J Pathol 162(1):303–312CrossRefPubMedPubMedCentral Lerman OZ et al (2003) Cellular dysfunction in the diabetic fibroblast: impairment in migration, vascular endothelial growth factor production, and response to hypoxia. Am J Pathol 162(1):303–312CrossRefPubMedPubMedCentral
15.
go back to reference McMurry JF Jr (1984) Wound healing with diabetes mellitus. Better glucose control for better wound healing in diabetes. Surg Clin North Am 64(4):769–778CrossRefPubMed McMurry JF Jr (1984) Wound healing with diabetes mellitus. Better glucose control for better wound healing in diabetes. Surg Clin North Am 64(4):769–778CrossRefPubMed
16.
go back to reference van Ramshorst GH et al (2010) Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 34(1):20–27CrossRefPubMed van Ramshorst GH et al (2010) Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 34(1):20–27CrossRefPubMed
17.
go back to reference De Berardis G et al (2012) Association of aspirin use with major bleeding in patients with and without diabetes. JAMA 307(21):2286–2294CrossRefPubMed De Berardis G et al (2012) Association of aspirin use with major bleeding in patients with and without diabetes. JAMA 307(21):2286–2294CrossRefPubMed
18.
go back to reference Hujoel PP, Stott-Miller M (2011) Retinal and gingival hemorrhaging and chronic hyperglycemia. Diabetes Care 34(1):181–183CrossRefPubMed Hujoel PP, Stott-Miller M (2011) Retinal and gingival hemorrhaging and chronic hyperglycemia. Diabetes Care 34(1):181–183CrossRefPubMed
19.
go back to reference Ochoa-Gonzalez F et al (2016) Metformin induces cell cycle arrest, reduced proliferation, wound healing impairment in vivo and is associated to clinical outcomes in diabetic foot ulcer patients. PLoS One 11(3):e0150900CrossRefPubMedPubMedCentral Ochoa-Gonzalez F et al (2016) Metformin induces cell cycle arrest, reduced proliferation, wound healing impairment in vivo and is associated to clinical outcomes in diabetic foot ulcer patients. PLoS One 11(3):e0150900CrossRefPubMedPubMedCentral
20.
go back to reference Ilhan YS et al (2005) The effect of an angiotensin converting enzyme inhibitor on intestinal wound healing. J Surg Res 128(1):61–65CrossRefPubMed Ilhan YS et al (2005) The effect of an angiotensin converting enzyme inhibitor on intestinal wound healing. J Surg Res 128(1):61–65CrossRefPubMed
22.
go back to reference Ljungqvist O (2010) Insulin resistance and outcomes in surgery. J Clin Endocrinol Metab 95(9):4217–4219CrossRefPubMed Ljungqvist O (2010) Insulin resistance and outcomes in surgery. J Clin Endocrinol Metab 95(9):4217–4219CrossRefPubMed
23.
go back to reference Ljungqvist O, Nygren J, Thorell A (2000) Insulin resistance and elective surgery. Surgery 128(5):757–760CrossRefPubMed Ljungqvist O, Nygren J, Thorell A (2000) Insulin resistance and elective surgery. Surgery 128(5):757–760CrossRefPubMed
24.
go back to reference Thorell A, Nygren J, Ljungqvist O (1999) Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care 2(1):69–78CrossRefPubMed Thorell A, Nygren J, Ljungqvist O (1999) Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care 2(1):69–78CrossRefPubMed
25.
go back to reference Black E et al (2003) Decrease of collagen deposition in wound repair in type 1 diabetes independent of glycemic control. Arch Surg 138(1):34–40CrossRefPubMed Black E et al (2003) Decrease of collagen deposition in wound repair in type 1 diabetes independent of glycemic control. Arch Surg 138(1):34–40CrossRefPubMed
26.
go back to reference Mullen JT, Moorman DW, Davenport DL (2009) The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250(1):166–172CrossRefPubMed Mullen JT, Moorman DW, Davenport DL (2009) The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250(1):166–172CrossRefPubMed
27.
go back to reference Rosemar A et al (2010) Effect of body mass index on groin hernia surgery. Ann Surg 252(2):397–401CrossRefPubMed Rosemar A et al (2010) Effect of body mass index on groin hernia surgery. Ann Surg 252(2):397–401CrossRefPubMed
28.
go back to reference Choban PS et al (1995) Increased incidence of nosocomial infections in obese surgical patients. Am Surg 61(11):1001–1005PubMed Choban PS et al (1995) Increased incidence of nosocomial infections in obese surgical patients. Am Surg 61(11):1001–1005PubMed
29.
go back to reference Winfield RD et al (2016) Obesity and the risk for surgical site infection in abdominal surgery. Am Surg 82(4):331–336PubMed Winfield RD et al (2016) Obesity and the risk for surgical site infection in abdominal surgery. Am Surg 82(4):331–336PubMed
30.
go back to reference Donohoe CL et al (2011) Perioperative evaluation of the obese patient. J Clin Anesth 23(7):575–586CrossRefPubMed Donohoe CL et al (2011) Perioperative evaluation of the obese patient. J Clin Anesth 23(7):575–586CrossRefPubMed
31.
go back to reference Stenberg E et al (2014) Is glycosylated hemoglobin A1 c associated with increased risk for severe early postoperative complications in nondiabetics after laparoscopic gastric bypass? Surg Obes Relat Dis 10(5):801–805CrossRefPubMed Stenberg E et al (2014) Is glycosylated hemoglobin A1 c associated with increased risk for severe early postoperative complications in nondiabetics after laparoscopic gastric bypass? Surg Obes Relat Dis 10(5):801–805CrossRefPubMed
32.
go back to reference Kwon S et al (2013) Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 257(1):8–14CrossRefPubMedPubMedCentral Kwon S et al (2013) Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 257(1):8–14CrossRefPubMedPubMedCentral
33.
go back to reference Kiran RP et al (2013) The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal surgery: evidence for the need for tight glucose control? Ann Surg 258(4):599–604 discussion 604-5PubMed Kiran RP et al (2013) The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal surgery: evidence for the need for tight glucose control? Ann Surg 258(4):599–604 discussion 604-5PubMed
Metadata
Title
Diabetes as a risk factor in patients undergoing groin hernia surgery
Authors
Gustaf Hellspong
Ulf Gunnarsson
Ursula Dahlstrand
Gabriel Sandblom
Publication date
01-03-2017
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 2/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-016-1519-8

Other articles of this Issue 2/2017

Langenbeck's Archives of Surgery 2/2017 Go to the issue