TY - CHAP M1 - Book, Section TI - Perioperative Risk Assessment and Management of the Diabetic Patient A1 - Lewis, Katherine A1 - L. Hermayer, Kathie A2 - McKean, Sylvia C. A2 - Ross, John J. A2 - Dressler, Daniel D. A2 - Scheurer, Danielle B. PY - 2017 T2 - Principles and Practice of Hospital Medicine, 2e AB - About 21 million adults have diabetes in the United States, and 5.5 million hospital discharges include diabetes as one of the listed diagnoses. Annual inpatient health care costs directly related to diabetes were estimated at $76 billion in 2012. People with diabetes have a higher lifetime probability of requiring surgery compared to the general population due to increased cardiovascular, ophthalmic, renal, and neuropathic complications from their disease. Diabetes mellitus itself may complicate surgical wound healing and recovery. Surgical site infections may be twice as high in patients with diabetes, potentially from small vessel disease impairing oxygen and nutrient delivery to tissues, impaired leukocyte and monocyte function due to hyperglycemia, and decreased release of neuropeptides in those with peripheral neuropathy. Patients with diabetes also have higher postoperative in-hospital mortality compared to those without diabetes. Patients with higher postoperative blood sugars after coronary bypass surgery have an increased rate of complications. Surgery and anesthesia provoke release of counter-regulatory hormones, which cause hyperglycemia and increased catabolism. Care for the surgical patient with diabetes should focus on avoidance of marked hyperglycemia, which can alter wound healing and disrupt fluid balance, while also avoiding hypoglycemia, which can cause cardiac stress. Perioperative evaluation for patients with diabetes allows for the development of an individualized plan to reduce perioperative complications and to determine a safe and effective diabetes discharge plan. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=1137608182 ER -