Comparative Study of Operative Complications in Diabetic and Non-Diabetic Patients: A Prospective Study

Résumé

Introduction: Diabetes mellitus is the most common endocrine disease. Diabetes mellitus involved an impairment in the normal utilization of carbohydrates, it become common practice to 'prepare' a person with diabetes for surgery by instituting a sudden and severe restriction of dietary carbohydrates and fat in off on to suppress glycosuria up to 24 hours of fasting. Aim of the study: Aim of the study was to evaluate the operative complications in diabetic and non-diabetic patients. Material & Methods: This study represents a prospective analysis of two hundred operative cases, half of these are diabetics and half of these are non-diabetics. Diabetic patients are mostly taken from BIRDEM, Dhaka, and nondiabetic patients are mostly taken from Dhaka Medical College Hospital, from July '05 to July '06. Patients of both the groups are approximate of similar age, and sex and have undergone a similar type of operation. Diabetic patients are assessed pre-operatively regarding their duration of diabetes. This study is intended to detect different surgical complications in controlled diabetics and compare them with that of nondiabetic patients in our country. Results: Eighty-five percent of diabetics are more than 40 years of age, on the other hand only half of the non-diabetics are above 40. 52 % of diabetic patients undergoing surgery are well controlled (2h AFB blood sugar level below 10 mmol/L) on admission to hospital either with diet or oral hypoglycemic agent or insulin. Maximum diabetic patients (41%) are taking oral anti-diabetic agents for their glycaemic control. Every fifth diabetic patient (21%) has got some form of ischemic heart disease due to coronary atherosclerosis, and 3% of diabetics have a history of myocardial infarction. 6 % of diabetic patients develop hypokalemia during the post-operative period. Patients requiring a higher dose of insulin (around 50 units! per day) are prone to develop hypokalemia. In this study, we found 8 % in diabetic and non-diabetic 6%. Diabetics with peripheral vascular disease are more prone to the development of wound infection. Conclusion: We conclude that hyperglycemia, hypokalemia and wound infections are much more common in these emergency cases. Large sample size and multicenter study should be required.