Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients.
BACKGROUND
Tight perioperative control of blood glucose improves the outcome of diabetic patients undergoing cardiac surgery. Because stress response and cardiopulmonary bypass can induce profound hyperglycemia, intraoperative glycemic control may become difficult. The authors undertook a prospective cohort study to determine whether poor intraoperative glycemic control is associated with increased intrahospital morbidity.


METHODS
Two hundred consecutive diabetic patients undergoing on-pump heart surgery were enrolled. A standard insulin protocol based on subcutaneous intermediary insulin was given the morning of the surgery. Intravenous insulin therapy was initiated intraoperatively from blood glucose concentrations of 180 mg/dl or greater and titrated according to a predefined protocol. Poor intraoperative glycemic control was defined as four consecutive blood glucose concentrations greater than 200 mg/dl without any decrease in despite insulin therapy. Postoperative blood glucose concentrations were maintained below 140 mg/dl by using aggressive insulin therapy. The main endpoints were severe cardiovascular, respiratory, infectious, neurologic, and renal in-hospital morbidity.


RESULTS
Insulin therapy was required intraoperatively in 36% of patients, and poor intraoperative glycemic control was observed in 18% of patients. Poor intraoperative glycemic control was significantly more frequent in patients with severe postoperative morbidity (37% vs. 10%; P < 0.001). The adjusted odds ratio for severe postoperative morbidity among patients with a poor intraoperative glycemic control as compared with patients without was 7.2 (95% confidence interval, 2.7-19.0).


CONCLUSIONS
Poor intraoperative control of blood glucose concentrations in diabetic patients undergoing cardiac surgery is associated with a worsened hospital outcome after surgery.
Ouattara
Alexandre
A
Institut de Cardiologie, Département d'Anesthésie-Réanimation, Service de Chirurgie Thoracique et Cardiovasculaire, Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.
Lecomte
Patrick
P
Le Manach
Yannick
Y
Landi
Marc
M
Jacqueminet
Sophie
S
Platonov
Igor
I
Bonnet
Nicolas
N
Riou
Bruno
B
Coriat
Pierre
P
D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D048909:Diabetes Complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012307:Risk Factors
D001786:Blood Glucose; D007328:Insulin