title: Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis.
abstract: OBJECTIVE
  Deep sternal wound infection (DSWI), especially in patients with diabetes mellitus (DM), is a major concern after coronary artery bypass grafting (CABG) with bilateral internal mammary artery (BIMA) grafts. We evaluated the risk of DSWI and other clinical outcomes between continuous insulin infusion therapy (CIT) and insulin sliding scale therapy (IST) in a cohort of DM patients who underwent CABG with BIMA.
  
  
  METHODS
  The clinical records of DM patients who underwent isolated CABG with BIMA were retrospectively reviewed. The study population consisted of 95 patients who received CIT and 126 patients who received IST. Furthermore, a one-to-one matched analysis based on estimated propensity scores for patients who received CIT or IST yielded two groups comprising 58 patients each. The proportion of patients with DSWI, overall survival rates and major adverse cardiac events were compared between the two groups in the overall and the propensity-matching cohort.
  
  
  RESULTS
  The prevalence of DSWI requiring debridement and closure was significantly reduced in the CIT group compared with that in the IST group [1/95 (1.1%) vs 9/126 (7.1%), P = 0.031]; these results were not attenuated even after propensity-matching analysis [0/58 (0%) vs 6/58 (10.3%), P = 0.031]. The mean preoperative glucose levels were similar between the two groups (157.5 ± 54.6 vs 176.1 ± ±70 mg/dl, P = 0.063), whereas the mean glucose values were significantly lower on the first and second operative days in the CIT group than in the IST group (132.9 ± 44.1 vs 197.8 ± 78.6 mg/dl, P < 0.0001; 153.5 ± 58.8 vs 199.6 ± 89.1 mg/dl, P < 0.0001, respectively). The glucose variability levels within 24 h postoperatively were significantly higher in the IST group (46.1 ± 19.4 vs 66.4 ± 26.8 mg/dl, P < 0.0001). The 30-day and 1-year survival rates were similar between the two groups (100 vs 99.2%, P = 0.384; 96.6 vs 94.4%, P = 0.454). No results were changed in the propensity-matching models.
  
  
  CONCLUSIONS
  The CIT approach reduced the variability in glucose concentration and resulted in fewer instances of DSWI after CABG with BIMA grafts.
authors.affiliation: Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan ogawa@heart-center.or.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ogawa
authors.affiliation: Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Okawa
authors.affiliation: Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Sawada
authors.affiliation: Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Koyama
authors.affiliation: Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Baba
authors.affiliation: Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003324:Coronary Artery Disease / Q000097:blood / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D061646:Operative Time; D011182:Postoperative Care / Q000379:methods; D057216:Propensity Score; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Bilateral internal mammary artery graft; Continuous insulin infusion; Coronary artery bypass grafting; Deep sternal wound infection; Surgical site infection