Association between intraoperative and early postoperative glucose levels and adverse outcomes after complex congenital heart surgery.
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.
Polito
Angelo
A
Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Thiagarajan
Ravi R
RR
Laussen
Peter C
PC
Gauvreau
Kimberlee
K
Agus
Michael S D
MS
Scheurer
Mark A
MA
Pigula
Frank A
FA
Costello
John M
JM
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
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin