RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 24 VOLUME 19 NUMBER 2 • November 2022 Impact of diabetes mellitus on the frequency of postoperative complications after carotid endarterectomy Correspondence to: Gojko Lj Igrutinović, Gojko Lj Igrutinović, Aleksandar R Jakovljević, Nikola M Miljković, Mladen N Kasalović, Surgery Clinic, Kosovska Mitrovica Clinical Hospital Centre, Kosovska, Mitrovica, Serbia e-mail: drgojkoigrutinovic@gmail.com Dragoslav Dj Nenezić, Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia Zlatan N Elek, Danijela R Vićentijević Medical Faculty, Kosovska, Mitrovica, Serbia S Afr J Diabetes Vasc Dis 2022; 19: 24–28 Stenotic occlusive diseases of the carotid arteries are some of the most frequent surgical vascular diseases, and the incidence is increasing, and carotid endarterectomy (CEA) is the most frequent operation carried out at vascular surgery clinics.1 It is well known Gojko Lj IgrutinoviC, Dragoslav Dj NeneziC, Aleksandar R JakovljeviC, Zlatan N Elek, Nikola M MiljkoviC, Mladen N KasaloviC, Danijela R ViCentijeviC ` ` ` ` ` ` ` Abstract Background: There is significant controversy surrounding the link between diabetes mellitus and post-operative complications after carotid endarterectomy (CEA). The aim of this study was to identify the possible effects of diabetes on the frequency of post-operative complications after CEA. Methods: This prospective study was conducted at the Dedinje Clinic for Vascular Surgery, Belgrade. The patients who underwent CEA were divided into two groups: group A (37.7%) included 98 (35.1%) insulin-dependent and 181 (64.9%) insulin-independent diabetic patients, and group B (62.3%) comprised non-diabetic subjects. Results: The pre-operative characteristics were similar, except for a greater prevalence of dyslipidaemia in patients with diabetes. Post-operative cardiac events occurred more often in patients with diabetes (3.6%) than in non-diabetic patients (1.1%) (p = 0.039); post-operative neurological events among patients with diabetes were 3.6% and among non-diabetics, 0.9% (p = 0.009). Peri-operative mortality rate was 2.5% in the diabetic group and 0.9% in the nondiabetic group. The total percentage of post-operative complications was two or more times higher in the diabetic group than the non-diabetic group (8.5 vs 18.3%, p < 0.001). Conclusions: Diabetes mellitus increased the surgical risk of CEA. Higher rates of mortality and post-operative complications were observed in patients being treated with oral antidiabetics than in those on insulin. Keywords: carotid endarterectomy, diabetes mellitus, postoperative complications that diabetes mellitus (DM) is a progressive disease that significantly contributes to degradation of atherosclerotic plaques in the arteries.2 CEA represents the first choice of treatment of high-level carotid stenosis and carries a low rate of post-operative morbidity and mortality.3 According to the literature, the percentage of patients with DM within the group of patients who undergo CEA has been on the rise, ranging from 10% to over 25%.4,5 On the other hand, diabetes is an important risk factor for the occurrence of myocardial infarction (MI) and stroke in the general population, and it can also impact on the outcome of CEA.6 Some authors believe that patients suffering from DM are at up to two times greater risk of overall post-operative complications compared to patients with no diabetes.6-8 On the other hand, others have observed that patients suffering from DM were exposed to the same risk of cardiological morbidity, mortality and stroke after CEA as patients with no diabetes.9-11 It has been proven that there is a risk of stroke in diabetic patients and it is related to the level of hyperglycaemia; it is assumed that controlled glycaemia may lower the risk of stroke.12 Since most of these studies have not taken into consideration the type of antidiabetic therapy, this could explain the contradictory results among studies on the influence of DM on the outcome of CEA. The aim of this article was to determine the frequency of post-operative complications after CEA in patients with or without DM, as well as to identify the type of antidiabetic therapy, in order to define the safety of the operation concerned. Methods This prospective, non-randomised study included all patients treated at the Institute for Cardiovascular Diseases, Dedinje, Belgrade, who, in the time period from December 2013 to December 2014, underwent CEA, and were entered into the prospective vascular registry. The patients were divided into two groups: group A (37.7%) consisted of 279 diabetic patients, including 98 (35.1%) being insulin-dependent and 181 (64.9%) taking oral hypoglycaemics. Group B (62.3%) consisted of 461 non-diabetics. A complete comparison of demographic characteristics and risk factors was done (gender, age, hypertension, hyperlipidaemia, smoking, pre-operative MI, concomitant vascular diseases). After the operation we compared post-operative complications [transient ischaemic attack (TIA), cerebrovascular infarction (CVI), MI, neurological, cardiological and other morbidities, and total mortality rate]. Control colour duplex sonography (CDS) of the carotid artery was carried out one month, six months and one year later. Our primary goal was 30-day morbidity and mortality, which is defined as any death or post-operative morbidity within 30 days of the treatment,
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