Perioperative diabetes related complications in patients undergoing major surgery are associated with the duration of gastrointestinal and orthopaedic surgery.
- 1Royal Wolverhampton NHS trust
Abstract
BackgroundDiabetes mellitus (DM) is a common chronic condition among surgical patients. It is associated with increased perioperative morbidity and mortality. Real-world data on the clinical predictors of postoperative complications in diabetic patients undergoing major surgery are limited. This study aimed to characterise perioperative outcomes and identify independent predictors of 28-day postoperative complications.
MethodsA retrospective cohort study at a single UK tertiary hospital. Adult patients with a known diagnosis of type 1 or type 2 diabetes mellitus who underwent major procedures under general anaesthesia between January 2020 and September 2025 were identified through electronic patient records (EPR). The primary outcome was any postoperative complication within 28 days. We used multivariable logistic regression to identify independent predictors of complications, adjusting for age, sex, ASA grade, surgical category, admission urgency, operative duration, diabetes type, HbA1c, and socioeconomic deprivation (Index of Multiple Deprivation [IMD]).
ResultsWe screened 2623 patients and included 267; we analysed 267 patients (260 with outcome data). The 28-day postoperative complication rate was 23.1% (46/199) among those with outcome data. Infection was the most common complication. In multivariate analysis, surgical duration was the only independent predictor of complications (adjusted odds ratio [aOR], 1.71; 95% CI, 1.16-2.51; p=0.007). Other variables were not associated with complications.
ConclusionsIn this study of patients with DM undergoing major surgery, operative duration was the only modifiable independent predictor of 28-day postoperative complications. Socioeconomic deprivation and preoperative HbA1c were not independently associated with outcomes, suggesting that standardised perioperative care pathways may attenuate these effects.
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BibTeX
@misc{chacko2026perioperative,
title = {{Perioperative diabetes related complications in patients undergoing major surgery are associated with the duration of gastrointestinal and orthopaedic surgery.}},
author = {C. J. Chacko and O. Reeve Chen and a. Binuraj and S. Cherukad and U. Saifuddin and S. Nourolahi-Oskoui and A. Nyarko and Z. Ahmed and S. Suresh and S. Renugappa and D. Singh Ranger and R. Raghavan and P. Nasa and T. Veenith},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.14.26362996},
url = {https://www.medrxiv.org/content/10.64898/2026.09.14.26362996v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Perioperative diabetes related complications in patients undergoing major surgery are associated with the duration of gastrointestinal and orthopaedic surgery.
AU - C. J. Chacko
AU - O. Reeve Chen
AU - a. Binuraj
AU - S. Cherukad
AU - U. Saifuddin
AU - S. Nourolahi-Oskoui
AU - A. Nyarko
AU - Z. Ahmed
AU - S. Suresh
AU - S. Renugappa
AU - D. Singh Ranger
AU - R. Raghavan
AU - P. Nasa
AU - T. Veenith
PY - 2026
DA - 2026/09/14
PB - medRxiv
DO - 10.64898/2026.09.14.26362996
UR - https://www.medrxiv.org/content/10.64898/2026.09.14.26362996v1
AB - BackgroundDiabetes mellitus (DM) is a common chronic condition among surgical patients. It is associated with increased perioperative morbidity and mortality. Real-world data on the clinical predictors of postoperative complications in diabetic patients undergoing major surgery are limited. This study aimed to characterise perioperative outcomes and identify independent predictors of 28-day postoperative complications. MethodsA retrospective cohort study at a single UK tertiary hospital. Adult patients with a known diagnosis of type 1 or type 2 diabetes mellitus who underwent major procedures under general anaesthesia between January 2020 and September 2025 were identified through electronic patient records (EPR). The primary outcome was any postoperative complication within 28 days. We used multivariable logistic regression to identify independent predictors of complications, adjusting for age, sex, ASA grade, surgical category, admission urgency, operative duration, diabetes type, HbA1c, and socioeconomic deprivation (Index of Multiple Deprivation [IMD]). ResultsWe screened 2623 patients and included 267; we analysed 267 patients (260 with outcome data). The 28-day postoperative complication rate was 23.1% (46/199) among those with outcome data. Infection was the most common complication. In multivariate analysis, surgical duration was the only independent predictor of complications (adjusted odds ratio [aOR], 1.71; 95% CI, 1.16-2.51; p=0.007). Other variables were not associated with complications. ConclusionsIn this study of patients with DM undergoing major surgery, operative duration was the only modifiable independent predictor of 28-day postoperative complications. Socioeconomic deprivation and preoperative HbA1c were not independently associated with outcomes, suggesting that standardised perioperative care pathways may attenuate these effects.
ER -