Extended Preoperative Glycemic Control Effect on Morbidity in CABG Patients

Introduction:

Glycemic control has significant impact on risk of post-operative infection

across a variety of surgical specialties. Studies suggest that peri-operative insulin

therapy can improve post-operative outcomes.

Primary endpoint: Proportions of Patients with surgical site infection (SSI), within 45

days of surgery, according to Centers for Disease Control and Prevention (CDC)

SSI criteria.

Secondary endpoints: Mortality and length of stay within 45 days of surgery.

This study tested the hypothesis that an extended duration of pre-operative in hospital moderately-tight glucose control (defined: 120-180 mg/dL) results in better postoperative results.

Materials and Methods:

This retrospective study included 389 diabetic patients who underwent

CABG operation at a Single Center Cardiac Surgery department during 2011-2015.

Inclusion criteria: 18 years of age or older, admission HBA1C>7.0%,

CABG operation – elective/urgent. Exclusion criteria: Antibiotic treatment other than department’s routine prophylactic regimen, and emergency/salvage operation.

Patients were classified into four research groups according to three risk factors:

EF<40%, BMI>30, Smoking:

1. Patients with no risk factors - Risk 0 (104),

2. Patients with one risk factor - Risk 1 (200),

3. Patients with two risk factors -Risk 2 (74),

4. Patients with three risk factors Risk 3 (11).

Results:

Patients who presented with HBA1C >8%, and were controlled for less than

24H, infections rate was 50.6% (39/77) compared to 33.1% (55/166) among those

who were controlled more than 24H (OR=2.63, p=0.002). Patients who presented

with HBA1C >8%, and were controlled more than 24H, only 7.8% (13/166) were

hospitalized more than 14 days - compared to 16.9% (13/77) among those who were

controlled for less than 24H (OR=4.43, p=0.007).

Conclusions:

Extended Duration of Preoperative In-Hospital Glucose Control is

independent risk factor for morbidity. Extending Duration of Glucose Control in

patients who present with HBA1C >8% for at least 24H, can significantly reduce the risk for post-operative surgical site infections and shorten length of stay.