Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting.
BACKGROUND
The association between perioperative hyperglycemia and outcomes in patients with and without diabetes mellitus undergoing coronary artery bypass grafting is not well defined. We measured the association between perioperative hyperglycemia and outcomes among patients undergoing coronary artery bypass grafting.


METHODS
We report a historic cohort study of 1574 patients who had undergone coronary artery bypass grafting between 1998 and 1999, 545 (34.6%) with diabetes. Perioperative blood glucose level was defined as the average of all blood glucose tests obtained on the day of and the day after surgery. Outcomes were 30-day mortality, infection rates (sternum, harvest site, sepsis, pneumonia, urinary tract), and resource utilization.


RESULTS
After adjusting for diabetes status and calculated preoperative mortality or mediastinitis risk scores, each 50 mg/dL (2.78 mmol/L) blood glucose increase was not statistically associated with higher mortality (odds ratio 1.37; 95% confidence interval, 0.98 to 1.92; p = 0.07), or higher infection rate (odds ratio 1.23, 95% confidence interval 0.94 to 1.60; p = 0.14). Each 50 mg/dL blood glucose increase was associated with longer postoperative days by 0.76 days (95% confidence interval 0.36 to 1.17 days; p < 0.001), increased hospitalization charges by 2824 dollars (95% confidence interval 1599 dollars to 4049 dollars; p < 0.001), and increased hospitalization cost by 1769 dollars (95% confidence interval 928 dollars to 2610 dollars; p < 0.001). In the unadjusted analysis, infections occurred more frequently in patients with diabetes (6.6% vs 4.1%, p = 0.03).


CONCLUSIONS
Perioperative hyperglycemia is associated with increased resource utilization in patients undergoing coronary artery bypass grafting with and without diabetes.
Department of Internal Medicine, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA. estradac@mail.ecu.edu
Carlos A
CA
Estrada
James A
JA
Young
L Wiley
LW
Nifong
W Randolph
WR
Chitwood
D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000191:economics / Q000401:mortality; D003428:Cross Infection; D003920:Diabetes Mellitus / Q000097:blood* / Q000191:economics; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D006943:Hyperglycemia; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection; D016896:Treatment Outcome
D001786:Blood Glucose