Non-infective morbidity in diabetic patients undergoing coronary and heart valve surgery.
OBJECTIVE
Studies of postoperative morbidity in diabetics have focussed on infection; however, autonomic and cardiovascular complications of diabetes potentially increase the risk for non-infective morbidity. We sought to investigate major non-infective early postoperative complications in diabetic patients.


METHODS
We identified diabetics who underwent CABG and/or valve operation from 1998 through 2007, and compared their clinical characteristics and outcome with a contemporaneous cohort of non-diabetic patients.


RESULTS
The demographic characteristics of 1145 diabetics were similar to 5534 non-diabetic patients (mean age 66+/-9 years vs 66+/-10 years, p=0.45, female 27.5% vs 26.7%, p=0.59, respectively). Class III/IV angina symptoms (43.9% vs 34.9%, p<0.0001), intravenous nitrates therapy (10.4% vs 6.6%, p<0.0001), heart failure (24.8% vs 20.4%, p=0.001), prior myocardial infarction (37% vs 31%, p<0.0001), ejection fraction </=0.50 (34.5% vs 23.0%, p<0.0001), triple vessel disease (66.3% vs 54.8%, p<0.0001), renal insufficiency (3.6% vs 1.5%, p<0.0001) and peripheral vascular disease (16.1% vs 8.7%) were prevalent amongst diabetics. The predominant operation was CABG (diabetic 84.8% vs non-diabetic 73.9%). Low cardiac output (28.3% vs 24.0%, p=0.002), renal dialysis (2.0% vs 0.8%, p<0.0001) and cerebrovascular events (5.1% vs 3.8%, p=0.04) more often complicated recovery of diabetic patients, but operative mortality was similar for both groups. However, postoperative myocardial infarction was less common in diabetics (0.5% vs 1.4%, p=0.02). Diabetes was not a risk factor for the composite endpoint of major non-infective morbidity and operative mortality (OR 1.15, 95% CI 0.97-1.37, p=0.10). Diabetic patients were prone to longer postoperative hospitalisation (9.7+/-10.5 days vs 8.4+/-6.7 days, p<0.0001) and discharge to a convalescence facilities (9.8% vs 6.9%, p<0.0001).


CONCLUSIONS
Diabetic patients present for surgery with higher prevalence of cardiovascular risk factors and are more likely to develop major non-infective complications, including cardiac, renal and neurological dysfunction, even though diabetes does not directly influence non-infective postoperative morbidity following CABG and/or valve operations.
Ngaage
Dumbor L
DL
Cardiothoracic centre, Castle Hill Hospital, Kingston-Upon-Hull, East Yorkshire, United Kingdom.
Jamali
Afil A
AA
Griffin
Steven
S
Guvendik
Levent
L
Cowen
Michael E
ME
Cale
Alexander R
AR
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D048909:Diabetes Complications / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications; D003928:Diabetic Nephropathies / Q000150:complications; D004812:Epidemiologic Methods; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000150:complications; D016896:Treatment Outcome