Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients.
OBJECTIVE
To estimate the magnitude of association between intraoperative hyperglycemia and perioperative outcomes in patients who underwent cardiac surgery.


METHODS
We conducted a retrospective observational study of consecutive adult patients who underwent cardiac surgery between June 10, 2002, and August 30, 2002, at the Mayo Clinic, a tertiary care center in Rochester, Minn. The primary independent variable was the mean intraoperative glucose concentration. The primary end point was a composite of death and infectious (sternal wound, urinary tract, sepsis), neurologic (stroke, coma, delirium), renal (acute renal failure), cardiac (new-onset atrial fibrillation, heart block, cardiac arrest), and pulmonary (prolonged pulmonary ventilation, pneumonia) complications developing within 30 days after cardiac surgery.


RESULTS
Among 409 patients who underwent cardiac surgery, those experiencing a primary end point were more likely to be male and older, have diabetes mellitus, undergo coronary artery bypass grafting, and receive insulin during surgery (P< or =.05 for all comparisons). Atrial fibrillation (n=105), prolonged pulmonary ventilation (n=53), delirium (n=22), and urinary tract infection (n=16) were the most common complications. The initial, mean, and maximal intraoperative glucose concentrations were significantly higher in patients experiencing the primary end point (P<.01 for all comparisons). In multivariable analyses, mean and maximal glucose levels remained significantly associated with outcomes after adjusting for potentially confounding variables, including postoperative glucose concentration. Logistic regression analyses indicated that a 20-mg/dL increase in the mean intraoperative glucose level was associated with an increase of more than 30% in outcomes (adjusted odds ratio, 1.34; 95% confidence Interval, 1.10-1.62).


CONCLUSIONS
Intraoperative hyperglycemia is an independent risk factor for complications, including death, after cardiac surgery.
Gandhi
Gunjan Y
GY
Department of Internal Medicine and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. gandhi.gunjan@mayo.edu
Nuttall
Gregory A
GA
Abel
Martin D
MD
Mullany
Charles J
CJ
Schaff
Hartzell V
HV
Williams
Brent A
BA
Schrader
Lisa M
LM
Rizza
Robert A
RA
McMahon
M Molly
MM
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology; D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003128:Coma / Q000453:epidemiology / Q000209:etiology; D003693:Delirium / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology; D006327:Heart Block / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D007432:Intraoperative Period; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology
D001786:Blood Glucose