Type 2 Diabetes Mellitus and Adverse In-Hospital Outcomes after Nephroureterectomy

INTRODUCTION:The effect of insulin dependence in type 2 diabetes mellitus (T2DM) on adverse in-hospital outcomes after nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) is unknown. METHODS:Descriptive statistics, propensity score matching (PSM), and multivariable regression models were applied to the National Inpatient Sample (2004-2019) UTUC patients treated with NU. T2DM was stratified between insulin-dependent (ID) and non-insulin-dependent (NID) subtypes. RESULTS:In 10,761 NU patients, rates of ID-T2DM, and NID-T2DM were 2.7% and 19.1%, respectively. During the study period, ID-T2DM rates increased from 0.1 to 4.2% (estimated annual percentage change [EAPC]: +11.8%, p < 0.001), whereas NID-T2DM rates increased from 13.6 to 18.0% (EAPC: +1.1%, p = 0.045). After PSM, ID-T2DM patients (294 vs. 588 nondiabetic controls) exhibited higher rates of blood transfusions (+4.9%) and genitourinary complications (+7.8%), as well as higher total hospital charges (THCs; +9.3%). After multivariable adjustment, these increases translated into higher odds of blood transfusions (odds ratio [OR]: 1.88, p = 0.008) and genitourinary complications (OR: 1.40, p = 0.027), as well as higher THCs (incidence rate ratio [IRR]: 1.08, p < 0.001). NID-T2DM patients (2,051 vs. 4,102 nondiabetic controls) exhibited smaller increases in blood transfusions (+2.5%) and THC (+5.3%), corresponding to OR 1.28 (p = 0.002) and IRR 1.05 (p < 0.001), respectively. CONCLUSION:Although ID-T2DM represents a relatively small subgroup, its rates increased over time. ID-T2DM was associated with higher rates of blood transfusions, genitourinary complications, and increased THC after NU. These findings suggest that ID-T2DM patients undergoing NU may represent a potential target population for perioperative optimization to reduce surgical morbidity and resource utilization.