Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy

• Published in: Journal of diabetes and its complications 2017-04, Vol.31 (4), p.742-747
• Main Authors: Cardona, Saumeth, Pasquel, Francisco J, Fayfman, Maya, Peng, Limin, Jacobs, Sol, Vellanki, Priyathama, Weaver, Jeff, Halkos, Michael, Guyton, Robert A, Thourani, Vinod H, Umpierrez, Guillermo E
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Aged; Algorithm; Blood Glucose - analysis; Body mass index; CABG; Clinical trials; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - economics; Coronary Artery Disease - complications; Coronary Artery Disease - economics; Coronary Artery Disease - surgery; Cost analysis; Cost Savings; Costs and Cost Analysis; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - drug therapy; Diabetes Mellitus - economics; Diabetic Angiopathies - complications; Diabetic Angiopathies - economics; Diabetic Angiopathies - surgery; Diabetic Cardiomyopathies - complications; Diabetic Cardiomyopathies - economics; Diabetic Cardiomyopathies - surgery; Drug Monitoring; Endocrinology & Metabolism; Female; Glucose; Health economics; Heart surgery; Hospital Costs; Humans; Hyperglycemia; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - administration & dosage; Insulin - adverse effects; Insulin - economics; Insulin - therapeutic use; Insulin Infusion Systems - adverse effects; Insulin Infusion Systems - economics; Intensive care; Laboratories; Length of Stay; Male; Medicaid; Medicare; Middle Aged; Mortality; Pharmacy; Postoperative Complications - economics; Postoperative Complications - prevention & control; Postoperative Complications - therapy; Standard deviation; Surgery complications; Surgical outcomes; Treatment Outcome
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2017.01.003

Abstract Background The financial impact of intensive (blood glucose [BG] 100–140 mg/dl [5.5–7.8 mM] vs. conservative (141–180 mg/dl (7.9–10.0 mM) glucose control in the ICU in patients, with and without diabetes, undergoing coronary artery bypass graft (CABG) surgery is not known. Methods This post-hoc cost analysis determined differences in hospitalization costs, resource utilization and perioperative complications in 288 CABG patients with diabetes (n = 143) and without diabetes (n = 145), randomized to intensive (n = 143) and conservative (n = 145) glucose control. Results Intensive glucose control resulted in lower BG (131.4 ± 14 mg/dl-(7.2 ± 0.8 mM) vs. 151.6 ± 17 mg/dl (8.4 ± 0.8 mM, p < 0.001), a nonsignificant reduction in the median length of stay (LOS, 7.9 vs. 8.5 days, p = 0.17) and in a composite of perioperative complications including wound infection, bacteremia, acute renal and respiratory failure, major cardiovascular events (42% vs 52%, p = 0.10) compared to conservative control. Median hospitalization costs were lower in the intensive group ($39,366 vs. $42,141, p = 0.040), with a total cost savings of $3654 (95% CI: $1780–$3723), than conservative control. Resource utilization for radiology (p = 0.008), laboratory (p = 0.014), consultation service (p = 0.013), and ICU utilization (p = 0.007) were also lower in the intensive group. Compared to patients without perioperative complications, those with complications had longer hospital length of stay (10.7 days vs. 6.7 days, p < 0.001), higher total hospitalization cost ($48,299 vs. $32,675, p < 0.001), and higher resource utilization units (2745 vs. 1710, p < 0.001). Conclusion Intensive glycemic control [BG 100–140 mg/dl (5.5–7.8 mM)] in patients undergoing CABG resulted in significant reductions in hospitalization costs and resource utilization compared to patients treated with conservative [BG 141–180 mg/dl (7.9–10.0 mM)] glucose control.