The effect of diabetes mellitus on perioperative outcomes following colorectal resectional surgery

Date of Approval
Application Number
21_000404
Technical Summary

Background:
Diabetes mellitus (DM) is a common condition with a UK prevalence of 3.9 million (1 in 17) people diagnosed with the condition that is expected to increase significantly. The disease impacts the morbidity and mortality outcomes following surgery with specific national guidance detailing its peri-operative management. DM affects more than 10% of patients undergoing surgery with a peri-operative mortality as high as 50% greater than those without the condition.

There have been several population-based cohort studies from Australia, the USA, the Netherlands and Denmark showing conflicting results regarding the post-operative outcomes of patient with DM following colorectal resection and specifically there is a lack of evidence from large primary and secondary care linked UK population data.

Objective:
To quantify the risk and therefore assess the impact DM confers following colorectal surgery compared to the general population and assess whether there are differences in outcomes between the types of DM including differences in treatment regimen. This will aid future guidance with respect to the peri-operative management of DM in the UK.

Design:
The linked primary and secondary care databases (Clinical Practice Research Datalink, Hospital Episode Statistics) together with mortality data from the Office of National Statistics will be used to establish a cohort of patients undergoing colorectal resectional surgery. 90-day mortality will be compared between those with DM and those without undergoing colorectal resectional surgery. We will control for the confounders of age, gender, BMI, smoking, malignant and benign disease, along with emergency and elective admission and whether the procedure was performed in a minimally invasive way (robotic or laparoscopic).

Outcomes:
We will provide stratified population-based estimates of the length of stay and mortality rates up to 1-year following colorectal surgery in diabetic patients.

Health Outcomes to be Measured

• 90-day mortality
• Length of hospital stay

Collaborators

David Humes - Chief Investigator - University of Nottingham
Christopher Lewis-Lloyd - Corresponding Applicant - University of Nottingham
Colin Crooks - Collaborator - University of Nottingham
Dileep Lobo - Collaborator - University of Nottingham

Linkages

HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation