Beldi, Guido

Schettle, Markus

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INVITED COMMENTARYEffect of Diabetes on Outcomes in Patients UndergoingEmergency Cholecystectomy for Acute CholecystitisMarkus Schettle • Guido BeldiPublished online: 30 May 2013 Socie´te´ Internationale de Chirurgie 2013In this study, one of the most prevalent diseases meets oneof the most frequently performed operations. This topic isbecoming more and more important because of theincreasing age of the surgical population, paralleling theincreasing incidence of diabetes.Karamanos et al. [1] analyzed data collected between2004 and 2010 in the American College of SurgeonsNational Surgical Quality Improvement Program (ACSNSQIP) database, focusing on 5,460 patients who underwentemergency inpatient cholecystectomy for acute cholecysti-tis. The main aim of the study was to identify the prevalenceof diabetes in this patient group and explore its effect onsurgical outcomes. Multivariate analysis revealed signifi-cantly more adverse events in patients with diabetes than innondiabetics, particularly regarding mortality, preoperativegallbladder perforation, and infectious complications.In light of the large database and robust multivariateanalysis, the authors provide relevant support for theirhypothesis. Of interest is the strong impact of diabetesmellitus on the presentation of cholecystitis, with a sig-nificantly increased incidence of preoperative gallbladderperforation. Potential causal interactions between theincidence of acute cholecystitis and diabetes will hopefullybe addressed in future studies.Another interesting finding is the impact of insulin useon local and systemic infections compared to its effect ondiabetic patients given oral medication and patients withoutdiabetes mellitus. The elevated incidence of infections isunlikely to be explained by the higher incidence of perfo-rations and longer hospital stays. Potentially complexinteractions between diabetes and other aspects of themetabolic syndrome—obesity, fatty liver disease, conse-quences of arteriosclerosis—may influence the incidenceof these outcome parameters.The impact of diabetes on some clinical outcomeparameters may be explained in part by differencesbetween the populations because despite being extensivemultivariate analysis might not entirely correct for allfactors that may have a causal effect on the observedevents.The data of this study pave the way for new studies thataddress therapeutic aspects in patients with diabetesundergoing laparoscopic cholecystectomy. Optimal bloodglucose levels and the intensity of the insulin treatment areof particular clinical interest in this population. With ourcurrent knowledge, it is unclear if local and systemiccomplications are altered by different approaches ofintraoperative and postoperative glucose control, includingtight glycemic control or standard care [2].The present article addresses a frequent and highly rel-evant clinical scenario. In future, surgeons need to inves-tigate further the relevance of the metabolic syndrome andassociated diseases to the pathogenesis, outcomes, andclinical management of their patient population.References1. Karamanos E, Sivrikoz E, Beale E et al (2012) Effect of diabeteson outcomes in patients undergoing emergency cholecystectomyfor acute cholecystitis. World J Surg. doi:10.1007/s00268-013-2086-62. NICE-SUGAR Study Investigators, Finfer S, Liu B, Chittock DRet al (2012) Hypoglycemia and risk of death in critically illpatients. N Engl J Med 367:1108–1118M. Schettle  G. Beldi (&)Department of Visceral Surgery and Medicine, Bern UniversityHospital, University of Bern, Bern, Switzerlande-mail: guido.beldi@insel.ch123World J Surg (2013) 37:2265DOI 10.1007/s00268-013-2113-7

Effect of Diabetes on Outcomes in Patients Undergoing Emergency Cholecystectomy for Acute Cholecystitis

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Effect of Diabetes on Outcomes in Patients Undergoing Emergency Cholecystectomy for Acute Cholecystitis

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