Vascular Surgery Now Considered Safe For Persons With Diabetes

Diabetics are often advised to avoid vascular surgery because the operation could make them worse instead of better; they have even been told they are better off having a leg amputated than having the procedure.

However, a new study should put persons with diabetes at ease. The study found that, in the short run, their risk of dying after vascular surgery was actually lower than that of those who did not have diabetes.

Physicians at Boston's Beth Israel Deaconess Medical Center reviewed surgical outcomes of 6,565 patients over a 10-year period, and found that the persons with diabetes had just under a 1 percent mortality rate following major vascular surgery. In previous studies, the death rate on the procedure has been as high as 4 percent, says study author Dr. Allen D. Hamdan.

"Having diabetes does not predict a higher risk for vascular surgery. In fact, there was a lower morbidity rate," says Hamdan, a vascular surgeon at Deaconess and an assistant professor of surgery at Harvard Medical School. "What this means is that people with diabetes should be treated like anyone else, on a case-by-case basis, with regard to surgery."

There are about 16 million persons with diabetes in the United States, and 800,000 new cases are diagnosed each year, Hamdan says. The disease compromises the circulatory system, so persons with diabetes have significantly more vascular problems such as clotting and risk of gangrene in their outer limbs.

"It is an underlying truth" that patients with diabetes have accelerated hardening of the arteries that leads to problems all over the body at an earlier age and at a more accelerated rate, he says.

This led to the belief that "diabetics were felt to have a different type of vascular damage than non-diabetics. The feeling was that those with diabetes had worse blockages than people without diabetes," Hamdan says. "Because of this, simply the presence of diabetes was thought to be an indicator of higher risk for surgery."

As a result, he says, patients were—and still are—often advised to have amputations rather than vascular surgery that might improve circulation.

However, Hamden and his colleagues statistically analyzed outcomes for surgeries in the arteries of the neck and extremities, as well as arteries leading to the heart. They found diabetics had a death rate of 0.96 percent, compared with a 1.46 percent rate for non-diabetics who had the same operation. Hamden says the results were a surprise.

However, he adds, his department works very closely with the Joslin Diabetes Center in Boston, and the outcome might reflect their careful attention to persons with diabetes.

"We have a very coordinated, multi-disciplinary system with close ties to endocrinologists, cardiologists, anesthesiologists, and nurses who specialize in diabetes," he says. "We have close follow-up, and there's never any confusion."

"Diabetics are at much more higher risk for vascular problems, so the results are very surprising," says Renee Meehan, the diabetic clinical nurse specialist at Tampa General Hospital in Florida.

The study also found, however, that diabetics were at a slightly higher risk of having a heart attack after the procedure. Moreover, the long-term survival rate was "significantly lower" among diabetics than in the non-diabetics.

Always consult your physician for more information regarding your individual risk.