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Nationwide study in France investigating the impact of diabetes on mortality in patients undergoing abdominal aortic aneurysm repair

Authors
  • Raffort, Juliette1, 2
  • Lareyre, Fabien3
  • Fabre, Roxane4
  • Mallat, Ziad5
  • Pradier, Christian6
  • Bailly, Laurent6
  • 1 Université Côte d’Azur, CHU, Inserm U1065, C3M,
  • 2 Institute 3IA Côte d’Azur, Université Côte d’Azur,
  • 3 Department of Vascular Surgery, Hospital of Antibes Juan-Les-Pins, Antibes, France
  • 4 Université Côte d’Azur,
  • 5 University of Cambridge,
  • 6 University Hospital of Nice, Université Côte d’Azur,
Type
Published Article
Journal
Scientific Reports
Publisher
Springer Nature
Publication Date
Sep 29, 2021
Volume
11
Identifiers
DOI: 10.1038/s41598-021-98893-x
PMID: 34588565
PMCID: PMC8481485
Source
PubMed Central
Keywords
Disciplines
  • Article
License
Unknown

Abstract

The aim of this nationwide study was to analyze the impact of diabetes on post-operative mortality in patients undergoing AAA repair in France. This 10-year retrospective, multicenter study based on the French National electronic health data included patients undergoing AAA repair between 2010 and 2019. In-hospital post-operative mortality was analyzed using Kaplan–Meier curve survival and Log-Rank tests. A multivariate regression analysis was performed to calculate Hazard Ratios. Over 79,935 patients who underwent AAA repair, 61,146 patients (76.5%) had at least one hospital-readmission after the AAA repair, for a mean follow-up of 3.5 ± 2.5 years. Total in-hospital mortality over the 10-year study was 16,986 (21.3%) and 4581 deaths (5.8%) occurred during the first hospital stay for AAA repair. Age over 64 years old, the presence of AAA rupture and hospital readmission at 30-day were predictors of post-operative mortality (AdjHR = 1.59 CI 95% 1.51–1.67; AdjHR = 1.49 CI 95% 1.36–1.62 and AdjHR = 1.92, CI 95% 1.84–2.00). The prevalence of diabetes was significantly lower in ruptured AAA compared to unruptured AAA (14.8% vs 20.9%, P < 0.001 for type 2 diabetes and 2.5% vs 4.0%, P < 0.001 for type 1 diabetes). Type 1 diabetes was significantly associated with post-operative mortality (AdjHR = 1.30 CI 95% 1.20–1.40). For type 2 diabetes, the association was not statistically significant (Adj HR = 0.96, CI 95% 0.92–1.01). Older age, AAA rupture and hospital readmission were associated with deaths that occurred after discharge from the first AAA repair. Type 1 diabetes was identified as a risk factor of post-operative mortality. This study highlights the complex association between diabetes and AAA and should encourage institutions to report long-term follow-up after AAA repair to better understand its impact.

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