Annals of surgical oncology · 2026
Type 2 Diabetes Mellitus Versus Adverse In-Hospital Outcomes After Partial or Radical Nephrectomy.
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Filzmayer Maximilian, Nicolazzini Michele, Catanzaro Calogero, Polverino Federico, Petix Michele, Quarta Leonardo, Goyal Jordan A, Volpe Alessandro, Schiavina Riccardo, Longo Nicola, Musi Gennaro, Briganti Alberto, Shariat Shahrokh F, Wenzel Mike, Kosiba Marina, Humke Clara, Saad Fred, Chun Felix K-H, Karakiewicz Pierre I
Аннотация
BACKGROUND: The effect of insulin-dependence in type 2 diabetes mellitus (T2DM) on adverse in-hospital outcomes after partial (PN) or radical nephrectomy (RN) is unknown.
PATIENTS AND METHODS: Descriptive statistics, propensity score matching (PSM), and multivariable logistic regression were applied to the National Inpatient Sample (2004-2019) patients with kidney cancer who underwent nephrectomy. T2DM was stratified between insulin-dependent (ID) and noninsulin-dependent (NID) subtypes.
RESULTS: In 31,909 patients treated with PN, rates of ID-T2DM versus NID-T2DM were 3.5% versus 20.0%, and 3.4% versus 20.9% in 57,029 patients treated with RN. During the study period, ID-T2DM rates increased from 0.02% to 5.4% (270-fold) in PN and from 0.3% to 6.3% (21-fold) in RN. NID-T2DM rates increased from 17.4% to 20.2% (1.2-fold) in PN and from 17.0% to 21.6% (1.3-fold) in RN. After PSM, patients with ID-T2DM who underwent PN (1109 versus 5545 nondiabetic controls) exhibited higher rates of adverse in-hospital outcomes with significant increases in six examined categories (7.9-2.3%; OR 1.6-1.3). ID-T2DM had a weaker effect (6.0-0.6%; OR 3.0-1.2) in patients treated with RN (1961 versus 3922 controls). Finally, NID-T2DM exerted a modest effect (3.5-2.5%, OR 1.4-1.2) in patients treated with PN (6400 versus 6400 controls) and the weakest effect (2.6-0.8%, OR 1.2-1.1) in patients treated with RN (11,924 versus 11,924 controls).
CONCLUSIONS: Although ID-T2DM is relatively rare, its rates increased drastically over time. ID-T2DM was most strongly associated with adverse in-hospital outcomes in patients treated with PN, both in absolute and relative terms. Therefore, patients with ID-T2DM undergoing PN may represent a particularly relevant target population for perioperative management optimization with respect to surgical risk.
PATIENTS AND METHODS: Descriptive statistics, propensity score matching (PSM), and multivariable logistic regression were applied to the National Inpatient Sample (2004-2019) patients with kidney cancer who underwent nephrectomy. T2DM was stratified between insulin-dependent (ID) and noninsulin-dependent (NID) subtypes.
RESULTS: In 31,909 patients treated with PN, rates of ID-T2DM versus NID-T2DM were 3.5% versus 20.0%, and 3.4% versus 20.9% in 57,029 patients treated with RN. During the study period, ID-T2DM rates increased from 0.02% to 5.4% (270-fold) in PN and from 0.3% to 6.3% (21-fold) in RN. NID-T2DM rates increased from 17.4% to 20.2% (1.2-fold) in PN and from 17.0% to 21.6% (1.3-fold) in RN. After PSM, patients with ID-T2DM who underwent PN (1109 versus 5545 nondiabetic controls) exhibited higher rates of adverse in-hospital outcomes with significant increases in six examined categories (7.9-2.3%; OR 1.6-1.3). ID-T2DM had a weaker effect (6.0-0.6%; OR 3.0-1.2) in patients treated with RN (1961 versus 3922 controls). Finally, NID-T2DM exerted a modest effect (3.5-2.5%, OR 1.4-1.2) in patients treated with PN (6400 versus 6400 controls) and the weakest effect (2.6-0.8%, OR 1.2-1.1) in patients treated with RN (11,924 versus 11,924 controls).
CONCLUSIONS: Although ID-T2DM is relatively rare, its rates increased drastically over time. ID-T2DM was most strongly associated with adverse in-hospital outcomes in patients treated with PN, both in absolute and relative terms. Therefore, patients with ID-T2DM undergoing PN may represent a particularly relevant target population for perioperative management optimization with respect to surgical risk.