Association Between Diabetes Mellitus and Intraoperative Awareness During General Anesthesia: A Retrospective Cohort Study

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DOI:

https://doi.org/10.5195/ijms.2026.3783

Keywords:

intraoperative awareness, general anesthesia, pharmacokinetics, surgery, diabetes mellitus

Abstract

Background: Despite advancements in anesthetic techniques, specific patient populations remain vulnerable to intraoperative awareness. Diabetes mellitus (DM), increasingly prevalent and often accompanied by significant comorbidities, may complicate anesthetic management and mask signs of inadequate anesthetic depth. This study investigates whether DM is independently associated with an increased risk of unintended intraoperative awareness.

Methods: A retrospective cohort analysis was conducted using the TriNetX research platform, a federated health database. Two cohorts were identified: patients with DM and a control group without DM undergoing surgery under general anesthesia (GA). Propensity-score matching (1:1) was used for demographics, comorbidity categories, procedure categories, and medication classes, with patients having cognitive impairment, chronic obstructive pulmonary disease, substance use disorder, cardiovascular disease or non-GA anesthetic technique excluded. The incidence of intraoperative awareness was compared between groups.

Results: After matching, 189,787 patients were included in each cohort (total n=379,574). The incidence of intraoperative awareness was significantly higher in the DM group (0.027%, n=52) compared to the non-DM group (0.017%, n=32). DM was associated with a statistically significant increased risk (absolute risk difference: 0.011%, 95% CI: 0.001–0.02%, p=0.0291). This corresponds to a 62.5% higher relative risk of documented intraoperative awareness (RR=1.625, 95% CI: 1.046–2.524; OR=1.625, 95% CI: 1.046–2.524).

Conclusion: DM was associated with a modestly higher relative risk, but a very small absolute difference, in documented intraoperative awareness. Given the observational design and residual imbalance in diabetes-related comorbidity, causality cannot be inferred. These findings support continued anesthetic vigilance in diabetic patients.

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2026-06-10

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Wang, Z., Nguyen, N. B., & Espiridion, E. (2026). Association Between Diabetes Mellitus and Intraoperative Awareness During General Anesthesia: A Retrospective Cohort Study . International Journal of Medical Students, 63–72. https://doi.org/10.5195/ijms.2026.3783

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Copyright (c) 2026 Zhenghao Wang, Ngoc Bich Nguyen, Eduardo Espiridion

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