Retrospective

NSQIP, 506 Pts----increased complications with IDDM, severe bleeding (p=<0.046), post operative
ventilation >48 hrs (p=<0.001), pneumonia (p=0.048), overall complications (p=0.005)

J Craniofac Surg. 2008 Jul;19(4):1080-4

2001-2004—orocutaneous fistula, flap infection, heamatoma, thrombosis, necrosis

122 pts

Diabetes< 0.01 negative prognosis with flap reconstruction

Smoking not significant factor –use local flaps

Impact of Diabetes Mellitus on Head and Neck Cancer Patients
Undergoing Surgery
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Milap D. Raikundalia, Christina H. Fang, MD, Eleonora F. Spinazzi, ...
First Published October 6, 2015 Research Article

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Abstract
Objective
The impact of diabetes mellitus (DM) on surgical outcomes and cost of care for
patients undergoing surgery for head and neck cancer (HNCA) is not well
established. We used the Nationwide Inpatient Sample to analyze the postoperative
impact of DM on HNCA patients.

Study Design
Population-based inpatient registry analysis.

Setting
Academic medical center.

Subjects and Methods

Discharge data from the Nationwide Inpatient Sample were analyzed for patients
undergoing HNCA surgery from 2002 to 2010. Patient demographics, comorbidities,
length of stay, hospital charges, and postoperative complications were compared
between HNCA patients with and without DM.

Results
Of 31,075 patients, 4029 patients (13.0%) had a DM diagnosis. DM patients were
older (65.7 ± 10.8 vs 61.1 ± 14.1 years old; P < .001), had more preexisting
comorbidities, had longer hospitalizations, and incurred greater hospital charges.
Compared with the non-DM cohort, DM patients experienced significantly higher
rates of postoperative infections (2.6% vs 2.1%, P = .025), cardiac events (9.0% vs
4.3%, P < .001), pulmonary edema/failure (6.6% vs 5.7%, P = .023), acute renal
failure (3.3% vs 1.5%, P < .001), and urinary tract infections (2.8 % vs 2.1%, P = .
005). No differences in surgical wound healing rates were observed (0.1 vs 0.1, P = .
794). On multivariate logistic regression corrected for age and race, DM patients had
greater odds of postoperative infections (1.382, P = .007), cardiac events (1.893, P <
.001), and acute renal failure (2.023, P < .001).

Conclusions
DM is associated with greater length of stay and hospital charges among HNCA
patients. DM patients have significantly greater rates of postoperative complications,
including postoperative infections, cardiac events, and acute renal failure.
Head and neck cancer patients: Impact of
diabetes mellitus on surgical outcomes
Article (PDF Available)  in Journal of B.U.ON.: official journal of the Balkan Union of Oncology
21(3):580 · May 2016 with 43 Reads

Cite this publication

Giovanni Scanelli

o 28.63

o Azienda Sanitaria Ulss 8 "Berica"

Andrea Ciorba

o 32.45

o Arcispedale Sant'Anna

 +3

Claudia Aimoni

o 28.53
 o University of Ferrara

Francesco Stomeo
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Abstract

Purpose: Cancer patients with significant comorbidities undergoing major surgical intervention are at
high risk for peri/ postoperative complications and a prolonged hospital stay. Diabetes mellitus is a
prevalent chronic metabolic disease, reported to affect surgery outcomes of malignancies. The
purpose of this article was to evaluate the impact of diabetes mellitus on the development of local
and systemic complications as well as the length of the hospital stay, after major surgery for Head
and Neck (H&N) cancer. Methods: A total of 168 patients suffering from H&N cancer, surgically
treated between 2004 and 2013 at our ENT Department, were included. Clinical records were
examined, particularly focusing on the onset of local and systemic complications and on the length of
the hospital stay. The subjects considered as diabetics were the ones with a history of physician-
diagnosed diabetes or those who were taking oral hypoglycemic drugs or insulin. For those without a
diagnosis of diabetes and not taking any antidiabetic medications, the value of fasting blood glucose
was used to assess the presence of diabetes, according to the American Diabetes Association
guidelines (glycaemia >126 mg/dl). The occurrence of local and systemic postoperative
complications, as well as the length of the hospital stay, were statistically compared between the
diabetic and non-diabetic group of patients. Results: 31 of 168 (18.5%) patients, surgically treated for
H&N cancer, had also been diagnosed with diabetes mellitus. Episodes of postoperative
complications in non-diabetic patients were 50.4%, whereas in diabetics 45.2%. The mean length of
hospital stay for non-diabetics was 28.1±14.8 days and for diabetics 32.2±24. In univariate and
multivariate analysis, no statistically significant differences were found when comparing the diabetic
to the non-diabetic group, in terms of occurrence of postoperative complications in respect to cancer
stage and length of hospitalization. In univariate and multivariate analyses none of the variables
studied was a risk factor for postoperative complications. Conclusions: This study provides evidence
that a good metabolic control of diabetes mellitus does not have impact on the occurrence of
peri/postoperative complications and therefore on the length of hospital stay of H&N cancer
patients. Key words: diabetes mellitus, head and neck cancer, postoperative complications

Head and neck cancer patients: Impact of diabetes mellitus on surgical outcomes (PDF Download
Available). Available from:
https://www.researchgate.net/publication/304395582_Head_and_neck_cancer_patients_Impact_of
_diabetes_mellitus_on_surgical_outcomes [accessed Jan 28 2018].