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The impact of youth‐onset type 2 diabetes on postoperative wound healing complications

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Youth‐onset type 2 diabetes mellitus is associated with a more rapid decline in β cells, and earlier onset of medical complications compared to adult‐onset diabetes. However, its impact on surgical… Click to show full abstract

Youth‐onset type 2 diabetes mellitus is associated with a more rapid decline in β cells, and earlier onset of medical complications compared to adult‐onset diabetes. However, its impact on surgical wounds remains less clear. Therefore, this study aimed to determine whether youth‐onset diabetes is a risk factor for wound healing complications in the 30‐day postoperative period. To do so, the National Surgical Quality Improvement Program Database years 2012–2019 was analysed. Patients aged 18–24 with non‐insulin‐dependent diabetes were included. Outcomes assessed included wound infections, wound dehiscence, readmissions, and reoperation. Univariate analysis identified differences between the diabetic and non‐diabetic cohorts after which, multivariate logistic regression was employed to control for potential confounding. Analysis included 1589 diabetic and 196,902 non‐diabetic patients ages 18–24. The diabetic cohort exhibited a higher proportion of female (83.8% vs. 55.2%, p < 0.001), non‐white (22.7% vs. 19.5%, p = 0.001), and Hispanic patients (16.2% vs. 13.6%, p = 0.002). Diabetic patients were less likely to have dirty or contaminated wounds (16.2% vs. 25.2%, p < 0.001); however had increased rates of superficial surgical site infections (SSSIs; 2.0% vs. 0.8%, p < 0.001) and readmission (4.0% vs. 3.0%, p = 0.026). After regression, diabetes remained a significant positive predictor of SSSI (odds ratio: 1.546, p = 0.022); however, it no longer significantly predicted 30‐day readmission. Overall, this analysis of a large multicentre surgical outcomes database found that when compared to non‐diabetics, youth‐onset diabetic patients exhibited a higher proportion of SSSIs in the 30‐day postoperative period. These infections were found, despite the diabetic cohort exhibiting lower rates of wound contamination. After controlling for confounding variables, youth‐onset diabetes remained a significant predictor of SSSI. Clinically, prevention and treatment of diabetes along with judicious wound care is recommended.

Keywords: onset type; wound healing; youth onset; healing complications; onset diabetes; type diabetes

Journal Title: Wound Repair and Regeneration
Year Published: 2022

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