Blood glucose level on postoperative day 1 is predictive of adverse outcomes after cardiovascular surgery

• Published in: Diabetes & metabolism 2010-02, Vol.36 (1), p.36-42
• Main Authors: Frioud, A, Comte-Perret, S, Nguyen, S, Berger, M.M, Ruchat, P, Ruiz, J
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; Blood Glucose - metabolism; Cardiovascular Surgical Procedures - adverse effects; Cardiovascular Surgical Procedures - mortality; Chirurgie; Coronary artery bypass Grafting; Diabetes; Diabetes Complications - blood; Diabetes Complications - drug therapy; Diabetes Complications - etiology; Diabetes Complications - prevention & control; Diabète; Endocrinology & Metabolism; Female; Hospital Mortality; Humans; Hyperglycaemia; Hyperglycémie; Hypoglycaemia; Hypoglycemic Agents - administration & dosage; Hypoglycémie; Insulin - administration & dosage; Intensive Care Units; Internal Medicine; Length of Stay; Male; Middle Aged; Mortality; Mortalité; Multivariate Analysis; Pontage aortocoronaire; Post-surgery monitoring; Predictive Value of Tests; Prognosis; Période périopératoire; Retrospective Studies; Surgery; Surveillance; Time Factors; Treatment Outcome
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2009.06.008

Abstract Aim Hyperglycaemia is now a recognized predictive factor of morbidity and mortality after coronary artery bypass grafting (CABG). For this reason, we aimed to evaluate the postoperative management of glucose control in patients undergoing cardiovascular surgery, and to assess the impact of glucose levels on in-hospital mortality and morbidity. Methods This was a retrospective study investigating the association between postoperative blood glucose and outcomes, including death, post-surgical complications, and length of stay in the intensive care unit (ICU) and in hospital. Results A total of 642 consecutive patients were enrolled into the study after cardiovascular surgery (CABG, carotid endarterectomy and bypass in the lower limbs). Patients’ mean age was 68 ± 10 years, and 74% were male. In-hospital mortality was 5% in diabetic patients vs 2% in non-diabetic patients (OR: 1.66, P = 0.076). Having blood glucose levels in the upper quartile range (≥ 8.8 mmol/L) on postoperative day 1 was independently associated with death (OR: 10.16, P = 0.0002), infectious complications (OR: 1.76, P = 0.04) and prolonged ICU stay (OR: 3.10, P < 0.0001). Patients presenting with three or more hypoglycaemic episodes (< 4.1 mmol/L) had increased rates of mortality (OR: 9.08, P < 0.0001) and complications (OR: 8.57, P < 0.0001). Conclusion Glucose levels greater than 8.8 mmol/L on postoperative day 1 and having three or more hypoglycaemic episodes in the postoperative period were predictive of mortality and morbidity among patients undergoing cardiovascular surgery. This suggests that a multidisciplinary approach may be able to achieve better postoperative blood glucose control.