title: The Impact of Diabetes on Early Outcomes after Routine Bilateral Internal Thoracic Artery Grafting.
abstract: BACKGROUND
  Increased risk of postoperative complications limits use of bilateral internal thoracic artery (BITA) grafting in diabetic patients. The authors' experience in routine BITA grafting was reviewed to investigate the impact of diabetes on early outcomes.
  
  
  METHODS
  Among the 4508 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery from January 1999 throughout August 2015, skeletonised BITA grafts were used in 3228 (71.6%) patients, 972 diabetic and 2256 non-diabetic. After one-to-one propensity score (PS)-matched analysis, 819 pairs of diabetic/non-diabetic patients were compared for postoperative outcomes. The operative risk was calculated for each patient according to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).
  
  
  RESULTS
  Although diabetic had higher risk profiles than non-diabetic patients both in unmatched (EuroSCORE II: 5.3±7.3% vs. 3±4.2%, p<0.0001) and PS-matched series (EuroSCORE II: 5.1±7.1% vs. 3.6±4.3%, p<0.0001), there were no differences in hospital mortality (2.2% vs. 1.8%, p=0.52 and 2.1% vs. 2.3%, p=0.74, respectively). In PS-matched pairs, the use of adrenergic agonists (p=0.03), postoperative bleeding (p=0.0055) and deep incisional sternal wound infection (p=0.0018) were more frequent in diabetic patients who had a mean of longer hospital stays (p=0.023).
  
  
  CONCLUSIONS
  Bilateral internal thoracic artery grafting may be routinely performed even in diabetic patients despite higher risk profiles. Increased postoperative complications prolong hospital stay but do not impact on early mortality.
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy. Electronic address: gius.gatti@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Dell'Angela
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Maschietto
authors.affiliation: Division of Infective Diseases, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Luzzati
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Pappalardo
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality / Q000601:surgery; D003925:Diabetic Angiopathies / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008323:Mammary Arteries; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000401:mortality*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000401:mortality*
keywords: Arterial grafts; Complications; Coronary artery bypass grafts; Diabetes mellitus; Outcomes; Surgery