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  • Association of type 2 diabetes with in-hospital complications among women undergoing breast cancer surgical procedures. A retrospective study using the Spanish National Hospital Discharge Database, 2013–2014

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Epidemiology
Research
Association of type 2 diabetes with in-hospital complications among women undergoing breast cancer surgical procedures. A retrospective study using the Spanish National Hospital Discharge Database, 2013–2014
  1. Ana Lopez-de-Andres1,
  2. Isabel Jimenez-Trujillo1,
  3. Valentin Hernandez-Barrera1,
  4. Javier de Miguel-Diez2,
  5. Manuel Mendez-Bailon3,
  6. Jose M de Miguel-Yanes4,
  7. Napoleon Perez-Farinos5,
  8. Miguel Angel Salinero-fort6,
  9. Jose L del Barrio1,
  10. Martin Romero-Maroto1,
  11. Rodrigo Jimenez-Garcia1
  1. 1Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
  2. 2Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  3. 3Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  4. 4Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  5. 5Health Security Agency, Ministry of Health, Social Services and Equality, Madrid, Spain
  6. 6Subdirección General de Investigación Sanitaria, Madrid, Spain
  1. Correspondence to Dr Rodrigo Jimenez-Garcia; rodrigo.jimenez{at}urjc.es

Abstract

Objectives To compare the type of surgical procedures used, comorbidities, in-hospital complications (IHC) and in-hospital outcomes between women with type 2 diabetes mellitus (T2DM) and age-matched women without diabetes who were hospitalised with breast cancer. In addition, we sought to identify factors associated with IHC in women with T2DM who had undergone surgical procedures for breast cancer.

Design Retrospective study using the National Hospital Discharge Database, 2013–2014.

Setting Spain.

Participants Women who were aged ≥40 years with a primary diagnosis of breast cancer and who had undergone a surgical procedure. We grouped admissions by T2DM status. We selected one matched control for each T2DM case.

Main outcome measures The type of procedure (breast-conserving surgery (BCS) or mastectomy), clinical characteristics, complications, length of hospital stay and in-hospital mortality.

Results We identified 41 458 admissions (9.23% with T2DM). Overall, and in addition to the surgical procedure, we found that comorbidity, hypertension and obesity were more common among patients with T2DM. We also detected a higher incidence of mastectomy in women with T2DM (44.69% vs 42.42%) and a greater rate of BCS in patients without T2DM (57.58% vs 55.31%). Overall, non-infectious complications were more common among women with T2DM (6.40% vs 4.56%). Among women who had undergone BCS or a mastectomy, IHC were more frequent among diabetics (5.57% vs 3.04% and 10.60% vs 8.24%, respectively). Comorbidity was significantly associated with a higher risk of IHC in women with diabetes, independent of the specific procedure used.province

Conclusions Women with T2DM who undergo surgical breast cancer procedures have more comorbidity, risk factors and advanced cancer presentations than matched patients without T2DM. Mastectomies are more common in women with T2DM. Moreover, the procedures among women with T2DM were associated with greater IHC. Comorbidity was a strong predictor of IHC in women with T2DM.

  • type 2 diabetes
  • breast cancer
  • mastectomy
  • breast-conserving surgery
  • complications
  • hospitalizations

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-017676

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    Footnotes

    • Contributors AL-de-A and RJ-G participated in the conception and design, analysis, interpretation and writing of the article. VH-B and IJ-T contributed their statistical expertise and towards conception and design, interpretation and writing of the article. JdeM-D, MM-B, JMdeM-Y, NP-F, MAS-F, JLdeB and MR-M were involved in the critical revision of the article, interpretation and design. All authors have seen and approved the final version.

    • Funding This study is part of research funded by the FIS (Fondo de Investigaciones Sanitarias-Health Research Fund, grants no. PI13/00118 and PI16/00564, Instituto de Salud Carlos III) co-financed by the European Union through the Fondo Europeo de Desarrollo Regional (FEDER, ’Una manera de hacer Europa') and by the Grupo de Excelencia Investigadora URJC-Banco Santander Nº30VCPIGI03: Investigación traslacional en el proceso de salud-enfermedad (ITPSE).

    • Competing interests None declared.

    • Ethics approval The study protocol was approved by the Ethics Committee of the Rey Juan Carlos University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.