Diabetes Increases Hospital Complications for Trauma Patients

HERSHEY, Pa., July 17 -- Diabetes complicates hospital trauma care much as it does for in-patient acute care, researchers here reported.
Data from Pennsylvania trauma centers over 18 years showed that hospitalized patients with diabetes were almost twice as likely as non-diabetics with injuries of similar severity to have a complication, although mortality rates were the same, reported Robert A. Cherry, M.D., of Penn State, and colleagues, in the July issue of the Archives of Surgery.
Studies have shown that diabetic patients have more complications and worse outcomes after hospitalization for stroke, myocardial infarction, and cardiothoracic surgery, but little had been known about outcomes for diabetic trauma patients, the authors noted.
Using the Pennsylvania Trauma Systems Foundation database, the researchers compared 12,489 patients from January 1984 through December 2002 matched by sex, age, and injury-severity score with a similar number of patients without diabetes. Both groups were 52% male.
There were no differences in mortality rates or length of hospital stay, the researchers reported.
Beyond that, the two groups fared differently. Diabetic patients:
Were more likely to have a complication (23% versus 14%, odds ratio, 1.80, 95% confidence interval, 1.69-1.92);
Were more likely to require ICU care (38.4% versus 35.9%, P<0.001);
Had longer ICU stays (7.6 days versus 6.1 days, P<0.001);
Required longer ventilation support (10.8 days versus 8.4 days), although the proportion of patients requiring ventilator support was similar in both groups;
Developed almost twice as many infections 11.3 % versus 6.3%).
Urinary tract infections were the most common infection in both groups but were more frequent in the diabetes group.
Decubitus ulcers and sepsis were more than twice as likely to occur in the patients with diabetes.
In addition, single and multiple pulmonary complications and cardiovascular complications were more common among diabetic patients, with the most common being major arrhythmia.
Finally, myocardial infarction and deep vein thrombosis were also more likely to occur among those with diabetes.
Patients with diabetes were less likely to be discharged to their home and were more likely to require skilled nursing care after discharge, which may have accounted for the similarity in the overall hospital-stay length, they said.
In addition, they suggested, improved diabetes treatment and advances in critical care and resuscitation, probably contributed to the comparable mortality rates in the groups.
The excess morbidity, they said, might have resulted from alterations in the immune system, level of glycemic control, or pre-existing comorbidities.
Acknowledging several study limitations, the researchers mentioned that this retrospective analysis gathered data from several institutions across the state and despite careful matching, may have included unidentified factors contributing to outcome.
A limitation of the database included having information only about whether a patient was using insulin before admission, as well as lack of information about glycohemoglobin level, admission glucose level, diabetes-related comorbidities, body mass index, medication compliance, and duration of diabetes.
No financial disclosures were reported. Additional source: Archives of SurgerySource reference: Ahmad R, et al "Increased Hospital Morbidity Among Trauma Patients With Diabetes Mellitus Compared With Age- and Injury Severity Score-Matched Control Subjects." Arch Surg. 2007; 142: 613-618.