Clinical and economic impact of diabetes following coronary artery bypass.
BACKGROUND
Diabetes has been shown to have a negative impact on mortality following coronary artery bypass graft (CABG) surgery. This analysis examines the impact of diabetes on additional clinical and economic outcomes.


METHODS
Between May and October of 1996, 312 consecutive patients undergoing isolated primary CABG were followed through hospital discharge. A total of 114 diabetics (37%) and 198 nondiabetics (63%) was evaluated. Among the diabetics, 62 (54%) were insulin requiring and 52 (46%) were treated with oral hypoglycemic agents or with diet alone.


RESULTS
The incidences of major clinical complications including death, renal failure, stroke, reexploration for bleeding, and mediastinitis or sternal dehiscence were not significantly different among insulin-requiring diabetics, noninsulin-requiring diabetics, and nondiabetics. However, insulin-requiring diabetics had a significantly longer (P < 0.01) total length of stay compared to both noninsulin-requiring diabetics and nondiabetics (107 +/- 12.7 days vs. 5.6 +/- 1.5 days vs. 6.8 +/- 5.4 days, respectively), a significantly longer (P < 0.01) intensive care unit length of stay (5.3 +/- 12.4 days vs. 1.4 +/- 0.8 days vs. 2.0 +/- 3.9 days, respectively), and significantly greater (P, 0.01) total hospital charges (48.7 +/- 56.1 thousand dollars vs. 29.3 +/- 4.3 thousand dollar vs. 32.9 +/- 18.9 thousand dollars, respectively). There were no significant differences between the noninsulin-requiring diabetics and the nondiabetics with regard to these clinical and economic outcomes.


CONCLUSIONS
Diabetics treated with oral hypoglycemic agents or with diet alone have clinical and economic outcomes similar to nondiabetics following CABG. Insulin-requiring diabetes, however, predicts significantly increased hospital resource utilization. Future outcome assessment and resource utilization analyses must stratify diabetes by treatment to be completely accurate.
Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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RD
Stewart
S J
SJ
Lahey
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Levitsky
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Sánchez
C T
CT
Campos
D000368:Aged; D002561:Cerebrovascular Disorders; D001026:Coronary Artery Bypass; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics; D003925:Diabetic Angiopathies / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008480:Mediastinitis; D008875:Middle Aged; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D051437:Renal Insufficiency