Assessment of perioperative risk in the patient with diabetes mellitus.

To define the preoperative clinical characteristics that identify patients with diabetes mellitus at increased risk for postoperative complications, and inception cohort of diabetic patients undergoing surgical treatment was examined. Serious cardiac morbidity and death were predicted by the presence of pre-existing cardiac disease, specifically, congestive heart failure and valvular heart disease. Patients at increased risk for non-cardiac complications (infection, renal insufficiency and cerebral ischemic events) included 24 per cent of those patients with diabetic end-organ disease (retinopathy, neuropathy and nephropathy), 29 per cent of those with congestive heart failure or valvular heart disease and 35 per cent of those with peripheral vascular disease and infection. In patients who did not have such pre-existing conditions, serious noncardiac complications were rare (4 per cent). Neither the severity of the disease nor the degree of perioperative glucose control were associated with increased postoperative morbidity or mortality. We conclude that, among patients with diabetes mellitus who are undergoing surgical procedures, postoperative complications can be predicted by the presence of readily identifiable preoperative clinical characteristics.