New
study shows a lower morbidity rate after vascular surgery and is
even lower than those who don’t have the disease.
Diabetics
are often advised to avoid vascular surgery because the operation
could make them worse instead of better; they're even told they're
better off having a leg amputated than having the procedure.
However,
a new study should put diabetics at ease. It finds that, in the
short run, their risk of dying after vascular surgery was actually
lower than that of those who didn't have the disease.
Doctors
at Boston's Beth Israel Deaconess Medical Center reviewed surgical
outcomes of 6,565 patients over a 10-year period, and found
diabetics had just under a 1 percent mortality rate following
major vascular surgery. In previous studies, the death rate on the
procedure has been as high as 4 percent, says study author Dr.
Allen D. Hamdan.
"Having
diabetes does not predict a higher risk for vascular surgery. In
fact, there was a lower morbidity rate," says Hamdan, a
vascular surgeon at Deaconess and an assistant professor of
surgery at Harvard Medical School. "What this means is that
people with diabetes should be treated like anyone else, on a
case-by-case basis, with regard to surgery."
There
are about 16 million diabetics in the United States, and 800,000
new cases are diagnosed each year, Hamdan says. The disease
compromises the circulatory system, so diabetics have
significantly more vascular problems such as clotting and risk of
gangrene in their outer limbs.
"It
is an underlying truth" that patients with diabetes have
accelerated hardening of the arteries that leads to problems all
over the body at an earlier age and at a more accelerated rate, he
says.
This
led to the belief that "diabetics were felt to have a
different type of vascular damage than non-diabetics. The feeling
was that those with diabetes had worse blockages than people
without diabetes," Hamdan says. "Because of this, simply
the presence of diabetes was thought to be an indicator of higher
risk for surgery."
As
a result, he says, patients were -- and still are -- often advised
to have amputations rather than vascular surgery that might
improve circulation.
However,
Hamden and his colleagues statistically analyzed outcomes for
surgeries in the arteries of the neck and extremities, as well as
arteries leading to the heart. They found diabetics had a death
rate of 0.96 percent, compared with a 1.46 percent rate for
non-diabetics who had the same operation. Hamden says the results
were a surprise.
"Diabetics
are at much more higher risk for vascular problems, so the results
are very surprising," says Renee Meehan, the diabetic
clinical nurse specialist at Tampa General Hospital in Florida.
The
study also found, however, that diabetics were at a slightly
higher risk of having a heart attack after the procedure.
Moreover, the long-term survival rate was "significantly
lower" among diabetics than in the non-diabetics.
SOURCES:
Allen D. Hamdan, M.D., vascular surgeon, Beth Israel Deaconess
Medical Center, and assistant professor, surgery, Harvard Medical
School, Boston; Renee Meehan, R.N., B.S.N., M.A., C.D.E., diabetic
clinical nurse specialist, Tampa General Hospital, Tampa, Fla.;
April 2002 Archives of surgery~DIAB~~HRTS~~SURG~
Fact:
For
every one-percentage point drop in the Hemoglobin A1c diabetes
complication rates drop by more than 25%.
Source:
Diabetes 2001: Vital Stats.
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