Surgery in a diabetic patient

Patients with diabetes undergoing surgical treatment are a common situation in today world. Several factors are responsible for high rate of various surgeries in diabetic patients.

• Rapidly increasing prevalence of diabetes
• Gradually increasing longevity of patients with diabetes
• Diabetes related complications requiring surgical treatment

When patients with diabetes undergo surgery, the complication rate is higher than non diabetics in same age group. Besides metabolic abnormalities of diabetes, associated macro and micro vascular complications, both known and silent and undiagnosed, are responsible for increased mortality and morbidity associated with surgery in a diabetic patient.

However with meticulous preoperative work up, attainment of good and steady metabolic control, and co-coordinated intra and post operative management, the mortality and morbidity associated with surgery in a diabetic patient can be reduced nearly to levels seen in non diabetic patients.

Stress associated with surgery and anaesthesia cause a lot of metabolic alterations, the degree of which depends on the amount of surgical trauma and duration of surgery

Preoperative evaluation is absolutely necessary to avoid complications. The main aims are to establish good metabolic control and to anticipate complications and take preventive measures.

Careful monitoring of blood glucose and appropriate adjustments in insulin infusions, monitoring of vital functions, intake and urine output, and ensuring adequate hydration and at the same time avoiding over hydration, particularly in elderly and those with impaired left ventricular function are important during post operative period.

Common post operative complications are –

-          Metabolic (diabetic ketoacidosis, hyper osmolar non ketotic state, hypoglycaemia, electrolyte disturbances)

-          Cardio vascular (myocardial infarction, left ventricular failure, cardiac arrhythmias, hypotension, stroke particularly after coronary artery bypass graft)

-          Renal (acute renal failure, fluid overload)

-          Infections

Careful preoperative assessment, well planned and co coordinated intra operative and post operative monitoring and management of diabetes, anticipation and preventive measures for complications goes a long way in decreasing perioperative mortality and morbidity in a diabetic patient undergoing surgical treatment