Diabetes Is Associated with Lower In-Hospital Mortality in Patients Undergoing Surgical Repair for Aortic Aneurysm Rupture

<b>Background</b>: Previous studies reported a protective effect of type 2 diabetes on the progression of aortic aneurysms. We aimed to investigate whether this paradoxical phenomenon remained in patients with diabetes undergoing repair of ruptured aortic aneurysms. <b>Methods</b>: Data from the US Nationwide Readmission Database from 2016 to 2019 were analyzed. Patients admitted for surgical repair of ruptured abdominal or thoracic aortic aneurysms were included. Patients discharged alive were followed for 30 days. The co-primary outcomes were in-hospital and 30-day mortality. <b>Results</b>: A total of 9858 patients hospitalized for surgical repair of ruptured abdominal or thoracic aortic aneurysm were included, of whom 16.4% had diabetes. A lower adjusted risk of in-hospital mortality in abdominal and thoracic aneurysms was observed in diabetes patients (aOR = 0.76 [0.67-0.87], 0.61 [0.46-0.810], respectively). However, atrial fibrillation and acute renal failure were more likely to occur in the presence of diabetes (aOR = 1.25 [1.11-1.42]; 1.17 [1.05-1.32], respectively). Within 30 days, diabetes was not associated with a difference in the incidence of mortality or readmission (aHR = 1.47 [95% CI 0.98-2.22]; 1.15 [95% CI 0.99-1.34], respectively). Cardiovascular system-related pathologies were the most prevalent etiologies in all readmitted patients. Infections were more likely to occur in the diabetes group (16.0% vs. 11.0%, respectively, <i>p</i> = 0.042). <b>Conclusions</b>: The paradoxical effect of diabetes is also observed in ruptured aneurysms treated surgically, as type 2 diabetes patients have a lower in-hospital mortality. However, this protective effect does not extend to 30-day readmission or survival.