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OBJECTIVE: To evaluate whether preoperative sodium-glucose cotransporter 2 inhibitor (SGLT2i) use is associated with postoperative complications in adults with type 2 diabetes mellitus (T2DM) undergoing open surgical tracheostomy (OST) METHODS: We performed a retrospective cohort study using a multi-institutional electronic health record network. Adults with T2DM who underwent OST between 2013 and 2024 were identified using CPT and ICD-10-PCS codes. Exposure was defined as an SGLT2i prescription within 180 days before surgery. One-to-one propensity score matching on demographics, comorbidities, preoperative ventilator dependence, medications, and laboratory values generated balanced SGLT2i and non-SGLT2i cohorts. Ninety- and 180-day postoperative complications were compared using odds ratios (ORs) with 95% confidence intervals, with Benjamini-Hochberg false discovery rate (FDR) correction. RESULTS: Of 36,840 eligible adults (1329 SGLT2i; 35,511 non-SGLT2i), 1327 patients remained in each cohort after matching. At 90 days, SGLT2i use was associated with higher odds of heart failure exacerbation (OR 1.70, 95% CI 1.36-2.14), which remained significant after FDR adjustment. At 180 days, SGLT2i use was associated with increased odds of hypoglycemia (OR 2.01, 95% CI 1.30-3.13) and heart failure exacerbation (OR 1.61, 95% CI 1.30-1.99), both significant after FDR correction. Signals for surgical site infection, tracheostomy stoma malfunction, and dizziness/vertigo did not remain significant after adjustment. CONCLUSION: In adults with T2DM undergoing OST, preoperative SGLT2i use was associated with increased postoperative hypoglycemia and heart failure exacerbation. These findings support careful perioperative management of SGLT2is in high-risk airway surgery and justify prospective studies to define optimal discontinuation strategies.
Singh et al. (Sun,) studied this question.