Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database
Introduction Limited information was available regarding the perioperative outcomes in patients with and without use of metformin. This study aims to evaluate the complications and mortality after major surgery in patients with diabetes who use metformin.Research design and methods Using a real-worl...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/8/2/e001351.full |
| _version_ | 1818562502894551040 |
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| author | Chao-Shun Lin Chuen-Chau Chang Chun-Chieh Yeh Yi-Cheng Chang Ta-Liang Chen Chien-Chang Liao |
| author_facet | Chao-Shun Lin Chuen-Chau Chang Chun-Chieh Yeh Yi-Cheng Chang Ta-Liang Chen Chien-Chang Liao |
| author_sort | Chao-Shun Lin |
| collection | DOAJ |
| description | Introduction Limited information was available regarding the perioperative outcomes in patients with and without use of metformin. This study aims to evaluate the complications and mortality after major surgery in patients with diabetes who use metformin.Research design and methods Using a real-world database of Taiwan’s National Health Insurance from 2008 to 2013, we conducted a matched cohort study of 91 356 patients with diabetes aged >20 years who used metformin and later underwent major surgery. Using a propensity score-matching technique adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 91 356 controls who underwent surgery but did not use metformin were selected. Logistic regression was used to calculate the ORs with 95% CIs for postoperative complications and 30-day mortality associated with metformin use.Results Patients who used metformin had a lower risk of postoperative septicemia (OR 0.94, 95% CI 0.90 to 0.98), acute renal failure (OR 0.87, 95% CI 0.79 to 0.96), and 30-day mortality (OR 0.79, 95% CI 0.71 to 0.88) compared with patients who did not use metformin, in both sexes and in every age group. Metformin users who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR 0.60, 95% CI 0.59 to 0.62) and lower medical expenditures (p<0.0001) than non-use controls.Conclusions Among patients with diabetes, those who used metformin and underwent major surgery had a lower risk of complications and mortality compared with non-users. Further randomized clinical trials are needed to show direct evidence of how metformin improves perioperative outcomes. |
| first_indexed | 2024-12-14T01:04:35Z |
| format | Article |
| id | doaj.art-828771d00e454a0cba97604051b48703 |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-12-14T01:04:35Z |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-828771d00e454a0cba97604051b487032022-12-21T23:23:02ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972020-12-018210.1136/bmjdrc-2020-001351Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world databaseChao-Shun Lin0Chuen-Chau Chang1Chun-Chieh Yeh2Yi-Cheng Chang3Ta-Liang Chen4Chien-Chang Liao5Department of Anesthesiology, Taipei Medical University Hospital, Taipei, TaiwanDepartment of Anesthesiology, Taipei Medical University Hospital, Taipei, TaiwanDepartment of Surgery, China Medical University Hospital, Taichung, TaiwanDivision of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanAnesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, TaiwanDepartment of Anesthesiology, Taipei Medical University Hospital, Taipei, TaiwanIntroduction Limited information was available regarding the perioperative outcomes in patients with and without use of metformin. This study aims to evaluate the complications and mortality after major surgery in patients with diabetes who use metformin.Research design and methods Using a real-world database of Taiwan’s National Health Insurance from 2008 to 2013, we conducted a matched cohort study of 91 356 patients with diabetes aged >20 years who used metformin and later underwent major surgery. Using a propensity score-matching technique adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 91 356 controls who underwent surgery but did not use metformin were selected. Logistic regression was used to calculate the ORs with 95% CIs for postoperative complications and 30-day mortality associated with metformin use.Results Patients who used metformin had a lower risk of postoperative septicemia (OR 0.94, 95% CI 0.90 to 0.98), acute renal failure (OR 0.87, 95% CI 0.79 to 0.96), and 30-day mortality (OR 0.79, 95% CI 0.71 to 0.88) compared with patients who did not use metformin, in both sexes and in every age group. Metformin users who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR 0.60, 95% CI 0.59 to 0.62) and lower medical expenditures (p<0.0001) than non-use controls.Conclusions Among patients with diabetes, those who used metformin and underwent major surgery had a lower risk of complications and mortality compared with non-users. Further randomized clinical trials are needed to show direct evidence of how metformin improves perioperative outcomes.https://drc.bmj.com/content/8/2/e001351.full |
| spellingShingle | Chao-Shun Lin Chuen-Chau Chang Chun-Chieh Yeh Yi-Cheng Chang Ta-Liang Chen Chien-Chang Liao Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database BMJ Open Diabetes Research & Care |
| title | Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database |
| title_full | Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database |
| title_fullStr | Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database |
| title_full_unstemmed | Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database |
| title_short | Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database |
| title_sort | outcomes after surgery in patients with diabetes who used metformin a retrospective cohort study based on a real world database |
| url | https://drc.bmj.com/content/8/2/e001351.full |
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