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ACOS 2024 Annual Clinical Assembly

Urological Surgery

Complication, Risk Factors, and Outcomes for Diabetics Undergoing Radical Prostatectomy​

Thursday, September 26, 2024
3:20 PM – 3:30 PM East Coast USA Time
Location: Mediterranean Salon 3, Lobby Level
Disclosure(s):
Virgil K. DeMario, M.A.: No financial relationships to disclose
Introduction/Purpose:

Prostate cancer is a significant healthcare challenge affecting a substantial number of men globally. One of the managements of clinically significant prostate cancer is radical prostatectomy, however, it is often complicated by the presence of comorbidities, particularly diabetes. This research aims to provide a comprehensive assessment of the complications that are associated with diabetes in patients undergoing radical prostatectomy for prostate cancer.

Methods or Case Description:

A retrospective review of NSQIP database from 2019 to 2020 to study patients who had undergone radical prostatectomy. The cohort was then subdivided into non-insulin diabetes, insulin dependent diabetes, and no diabetes group. A 30-day complication rate was than calculated for each group. Then, the Random Forest Algorithm informed the multivariate logistic regression.

Outcomes:

A total of 14,130 patients were included in the analysis with 12,147 (85.9%) non-diabetic, 427 (3.0%) with insulin dependent diabetes, and 1,556 (11.0%) diabetics controlled with oral medication. The diabetic group were older, higher BMI, and were more likely to be hypertensive. Overall complication rate was 7%, highest in the insulin dependent diabetes group at 12.4% compared to the 10.3% of non-insulin dependent group and 9.2% of the non-diabetic group (Table). On adjusted analysis, insulin dependent diabetics had higher odds of prolonged operation time (OR 1.13, 1.02-1.51) and were likely to have malignancy on pathological staging (OR 1.28, 1.02-1.62).



Conclusion:

Diabetes is a known risk factor in major urological surgery. We show that diabetics undergoing RP had higher complications compared to non-diabetics. Diabetics were older and likely to be African American. Specifically, diabetics had higher odds of prolonged operation time and higher stage malignancy. Insulin dependent diabetics had worse outcomes compared to diabetics controlled with oral medication.

Learning Objectives:

  • Understand the Impact of Diabetes on Radical Prostatectomy Outcomes: Attendees will learn about the specific complications associated with diabetes in patients undergoing radical prostatectomy and how these complications compare between insulin-dependent, non-insulin-dependent, and non-diabetic patients.
  • Identify Key Risk Factors Associated with Poor Outcomes in Diabetic Patients: Attendees will be able to identify the significant risk factors, such as prolonged operation time and higher odds of malignancy, that contribute to worse outcomes in diabetics undergoing radical prostatectomy.
  • Differentiate Between Outcomes Based on Diabetes Control: Attendees will gain insights into how outcomes differ between patients with insulin-dependent diabetes and those with non-insulin-dependent diabetes, highlighting the importance of diabetes management in surgical outcomes.
  • Evaluate the Clinical Implications for Managing Diabetic Patients Undergoing Radical Prostatectomy: Attendees will explore the clinical implications of the study findings, including the need for tailored perioperative management strategies for diabetic patients, particularly those with insulin dependency, to improve surgical outcomes.