title: Association between intraoperative and early postoperative glucose levels and adverse outcomes after complex congenital heart surgery.
abstract: BACKGROUND
  This study sought to determine whether associations exist between perioperative glucose exposure, prolonged hospitalization, and morbid events after complex congenital heart surgery.
  
  
  RESULTS
  Metrics of glucose control, including average, peak, minimum, and SD of glucose levels, and duration of hyperglycemia were determined intraoperatively and for 72 hours after surgery for 378 consecutive high-risk cardiac surgical patients. Multivariable regression analyses were used to determine relationships between these metrics of glucose control, hospital length of stay, and a composite morbidity-mortality outcome after controlling for multiple variables known to influence early outcomes after congenital heart surgery. Intraoperatively, a minimum glucose <or=75 mg/dL was associated with greater adjusted odds of reaching the composite morbidity-mortality end point (odds ratio [OR], 3.10; 95% confidence interval [CI], 1.49 to 6.48), but other metrics of glucose control were not associated with the composite end point or length of stay. Greater duration of hyperglycemia (glucose >126 mg/dL) during the 72 postoperative hours was associated with longer duration of hospitalization (P<0.001). In the 72 hours after surgery, average glucose <110 mg/dL (OR, 7.30; 95% CI, 1.95 to 27.25) or >143 mg/dL (OR, 5.21; 95% CI, 1.37 to 19.89), minimum glucose <or=75 mg/dL (OR, 2.85; 95% CI, 1.38 to 5.88), and peak glucose level >or=250 mg/dL (OR, 2.55; 95% CI, 1.20 to 5.43) were all associated with greater adjusted odds of reaching the composite morbidity-mortality end point.
  
  
  CONCLUSIONS
  In children undergoing complex congenital heart surgery, the optimal postoperative glucose range may be 110 to 126 mg/dL. Randomized trials of strict glycemic control achieved with insulin infusions in this patient population are warranted.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Michael S D
authors.initials: MS
authors.lastname: Agus
authors.forename: Mark A
authors.initials: MA
authors.lastname: Scheurer
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin