Mortality in diabetic patients undergoing non-cardiac surgery: a 7-year follow-up study

Acta Anaesthesiol Scand. 2009 Jul;53(6):749-58. doi: 10.1111/j.1399-6576.2009.01963.x. Epub 2009 Apr 14.


Background: The prognosis of diabetic patients after non-cardiac surgery remains controversial. This study was designed to compare the long-term mortality between diabetic and non-diabetic control patients undergoing non-cardiac surgery and to evaluate the possible risk factors.

Methods: We investigated 274 consecutive diabetic patients and 282 non-diabetic control patients who underwent non-cardiac surgery within 1 year in a tertiary care hospital in Finland. The control group was matched for the same type of operations. Patients were followed for up to 7 years on average. The main outcome measure was mortality within 7 years.

Results: Mortality both in the short-term postoperatively (< or =21 days) and in the long-term (up to 87 (1/2) months) was significantly higher in the diabetic patients compared with the non-diabetic group: 3.5 vs. 0% (P<0.05) and 37.2 vs. 15% (P<0.00001), respectively. The major causes of death among diabetic subjects were diseases of the cardiovascular system (56.8%) compared with non-diabetic patients (18.6%), P<0.0001. We found that diabetes mellitus per se is not a risk factor for post-operative mortality but a combination of variables had a significant effect on both short- and long-term mortality.

Conclusion: Diabetic patients undergoing non-cardiac surgery had a significantly higher incidence of short-term post-operative and long-term mortality compared with non-diabetic subjects. We propose a model of predictors of death among diabetic individuals undergoing non-cardiac surgery within a 7-year follow-up. The majority of deaths were associated with cardiovascular diseases.

MeSH terms

  • Age Factors
  • Aged
  • Body Mass Index
  • Cause of Death
  • Diabetes Mellitus / mortality*
  • Diabetes Mellitus, Type 1 / mortality
  • Diabetes Mellitus, Type 2 / mortality
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / metabolism
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / mortality
  • Risk Factors
  • Surgical Procedures, Operative / mortality*
  • Survival Analysis


  • Glycated Hemoglobin A