Structural Analysis Of Critical Factors Of Postoperative Complications In Diabetic Patients: Application Of The MICMAC Method

Abstract

Background: Diabetes mellitus significantly increases the risk of postoperative complications, but most studies have analyzed risk factors in isolation, without considering their systemic interdependencies.

Methods: A prospective-analytical study with a structural approach was carried out using the MICMAC method to identify and classify critical variables associated with postoperative complications in diabetic patients. Variables were selected through a systematic review (2015–2023) and validated using a modified Delphi panel with experts in surgery and related medical disciplines. A matrix of direct influence was constructed, and driving force and dependency indices were calculated.

Results: A total of fifteen variables were analyzed. Perioperative glycemic control, cardiovascular comorbidities, duration and complexity of surgery, antibiotic prophylaxis, and adherence to perioperative protocols were classified as key determinants with high driving force in the system. Link variables, such as preoperative glycosylated hemoglobin and type of anesthesia, among others, showed high influence and high dependence, evidencing system instability. Dependent factors such as diabetic nephropathy and advanced age appeared as consequences of the system. Sensitivity analysis confirmed the robustness of the classification.

Conclusions: Postoperative complications in diabetic patients arise from a highly interrelated system that combines clinical, surgical, and organizational determinants. The MICMAC method represents an innovative approach to prioritize risk factors and design safer surgical protocols tailored to this high-risk population.