RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 26 VOLUME 19 NUMBER 2 • November 2022 non-diabetics (0.9%) (p = 0.009). Post-operative CVI occurred in 1.3% of patients without diabetes and in 3.2% of patients with diabetes (χ2 = 3.241; p = 0.072). Cumulative neurological events TIA/cerebrovascular infarction were also statistically more numerous in the diabetic group (p = 0.02). Adverse post-operative cardiac events (MI, CHF) occurred in 3.6% of patients with diabetes and in 1.1% of non-diabetic patients (Fisher’s test of accurate probability; p = 0.039). Haematoma of the surgical wound occurred in 11 patients (2.4%) without DM and in 10 patients (3.6%) with DM, which was statistically significantly different (χ2 = 0.905; p = 0.341). Infection of the operated wound in our study was present in 1.8% of patients with DM, while none of the patients without DM had wound infection, which was statistically significant (Fisher’s test of accurate probability; p = 0.007). We observed that 0.9% of non-DM patients and 0.7% of DM patients had symptoms of cranial nerve lesions, which was statistically insignificant (Fisher’s test of accurate probability; p = 1.000). Post-operative restenosis occurred in 2.2% of patients without DM and in 1.8% of those with DM. The total rate of complications, shown in Table 3, was within the recommended limits. With regard to the rates of mortality and total morbidity, the two groups differed considerably from one another. Operative and post-operative mortality (neurological and cardiological) was 2.5% in the diabetic group (four cardiac events and three cerebrovascular infarctions) and 0.9% in the nondiabetic group (three MIs and one cerebrovascular infarction) (p = 0.113). The patients with DM had statistically significantly higher total mortality rates. Total post-operative complications were observed in 8.5% of patients without DM and in 18.3% of patients with DM (χ2 = 15.688; p < 0.001). Post-operative complications occurred in DM patients considerably more frequently (two or more times). One hundred and eighty-one DM patients (64.9%) were using oral antidiabetics and 98 (35.1%) were on insulin. Total postoperative complications occurred in 25.4% of patients on oral antidiabetics and in 8.2% of patients on insulin (χ2 = 12.122; p < 0.001). Post-operative complications occurred in patients on oral antidiabetics considerably more frequently than in those using insulin (Table 4). The stratification of patients with diabetes according to their levels of glycosylated haemoglobin (HbA1c) has shown that the group with HbA1c levels > 7.6 % had a higher total morbidity and mortality rate (Table 5). The median value of HbA1c in patients without post-operative complications was 7.6 ± 1.2, whereas the median value of HbA1c in patients with post-operative complications was 8.4 ± 0.9 (t = 5.010; p < 0.001). Patients with post-operative complications had significantly higher values of HbA1c. The multiple logistic regression model, with post-operative complications as a dependent variable, was supplemented with those predictors of post-operative complications that were statistically significant in the simple logistic regression model, the significance level being 0.05. Statistically significant predictors of early post-operative complications in the multiple logistic regression model were: age (B = 0.069; < 0.001) with odds ratio (OR) = 1.07, and it demonstrates that with increase in age of one year there is a 7% greater risk for patients to develop early post-operative complications. Diabetes (B = 0.854; p = 0.001) had an OR of 2.35, showing that diabetic patients were, with all other factors in the model controlled, at 2.35 times greater risk of the development of early post-operative complications. Concomitant coronary artery disease patients (B = 0.844; p = 0.001), (OR = 2.33) were at 2.33 times greater risk of the development of post-operative complications, with all other factors in the model controlled. With logistic regression, the factors identified to increase the odds of death and post-operative complications were: hyperlipoproteinaemia (p = 0.021), more persistent coronary artery disease (p = 0.001) and a higher frequency of peripheral arterial disease (p < 0.001). The factors determined to increase the odds of death and total morbidity were: higher levels of HbA1c (p < 0.001) and oral antidiabetics for controlling glucose levels (p < 0.001), which is shown in Tables 4 and 5. Discussion Although previous studies evaluated the connection between diabetes and a greater operative risk during CEA, there are various conflicting results in many studies. Most studies introduce CEA as a well-known and permanent procedure for the prevention of TIA and cerebrovascular infarction in patients with significant stenosis of the carotid artery.15 In previous studies, which included patients operated on for stenotic occlusive disease of the carotid arteries, the percentage of diabetics in most cases ranged from 13 to 23.6%.6,15 Our series included 37.7% of patients with diabetes, which is considerably higher compared to the study done by Ahari et al., which had 13% diabetic patients.5 Dorigo et al. report that the percentage of DM patients was 20.05%, whereas the study by Rockman et al. Table 3. Total mortality and morbidity rates in patients with diabetes and without diabetes who underwent CEA Group A: Group B: Structure of patients diabetics non-diabetics Total p-value Fatal cardiac event, n (%) 4 (1.4) 3 (0.7) 7 (0.9) 0.435 Fatal neurological event, n (%) 3 (1.1) 1 (0.2) 4 (0.5) 0.153 Total mortality, n (%) 7 (2.5) 4 (0.9) 11 (1.5) 0.113 Total morbidity, n (%) 51 (18.3) 39 (8.5) 90 (12.2) < 0.01 Table 5. HbA1c level in examined patients HbA1c level Number % SD Median Minimum Maximum Without post-operative 225 7.6 1.2 8.0 6.0 9.8 complications With post-operative 54 8.4 0.9 8.5 6.0 9.5 complications Total 279 7.8 1.2 8.0 6.0 9.8 Table 4. Distribution of patients depending on diabetes therapy, in relation to post-operative complications Oral antidiabetics Insulin therapy Total Post-operative complications n % n % n % Not present 135 74.6 90 91.8 225 80.6 Present 46 25.4 8 8.2 54 19.4 Total 181 100.0 98 100.0 279 100.0
RkJQdWJsaXNoZXIy NDIzNzc=