Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy.
BACKGROUND
The financial impact of intensive (blood glucose [BG] 100-140mg/dl [5.5-7.8mM] vs. conservative (141-180mg/dl (7.9-10.0mM) glucose control in the ICU in patients, with and without diabetes, undergoing coronary artery bypass graft (CABG) surgery is not known.


METHODS
This post-hoc cost analysis determined differences in hospitalization costs, resource utilization and perioperative complications in 288 CABG patients with diabetes (n=143) and without diabetes (n=145), randomized to intensive (n=143) and conservative (n=145) glucose control.


RESULTS
Intensive glucose control resulted in lower BG (131.4±14mg/dl-(7.2±0.8mM) vs. 151.6±17mg/dl (8.4±0.8mM, p<0.001), a nonsignificant reduction in the median length of stay (LOS, 7.9 vs. 8.5days, p=0.17) and in a composite of perioperative complications including wound infection, bacteremia, acute renal and respiratory failure, major cardiovascular events (42% vs 52%, p=0.10) compared to conservative control. Median hospitalization costs were lower in the intensive group ($39,366 vs. $42,141, p=0.040), with a total cost savings of $3654 (95% CI: $1780-$3723), than conservative control. Resource utilization for radiology (p=0.008), laboratory (p=0.014), consultation service (p=0.013), and ICU utilization (p=0.007) were also lower in the intensive group. Compared to patients without perioperative complications, those with complications had longer hospital length of stay (10.7days vs. 6.7days, p<0.001), higher total hospitalization cost ($48,299 vs. $32,675, p<0.001), and higher resource utilization units (2745 vs. 1710, p<0.001).


CONCLUSIONS
Intensive glycemic control [BG 100-140mg/dl (5.5-7.8mM)] in patients undergoing CABG resulted in significant reductions in hospitalization costs and resource utilization compared to patients treated with conservative [BG 141-180mg/dl (7.9-10.0mM)] glucose control.
Department of Medicine, Emory University, Atlanta, GA.
Saumeth
S
Cardona
Department of Medicine, Emory University, Atlanta, GA.
Francisco J
FJ
Pasquel
Department of Medicine, Emory University, Atlanta, GA.
Maya
M
Fayfman
Rollins School of Public Health, Emory University, Atlanta, GA.
Limin
L
Peng
Department of Medicine, Emory University, Atlanta, GA.
Sol
S
Jacobs
Department of Medicine, Emory University, Atlanta, GA.
Priyathama
P
Vellanki
Center for Comprehensive Informatics, Emory University, Atlanta, GA.
Jeff
J
Weaver
Joseph B. Whitehead Department of Surgery, Atlanta, GA; Emory University, Atlanta, GA.
Michael
M
Halkos
Joseph B. Whitehead Department of Surgery, Atlanta, GA; Emory University, Atlanta, GA.
Robert A
RA
Guyton
Joseph B. Whitehead Department of Surgery, Atlanta, GA; Emory University, Atlanta, GA.
Vinod H
VH
Thourani
Department of Medicine, Emory University, Atlanta, GA. Electronic address: geumpie@emory.edu.
Guillermo E
GE
Umpierrez
D000046:Academic Medical Centers; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000191:economics; D003324:Coronary Artery Disease / Q000150:complications / Q000191:economics / Q000601:surgery*; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D003925:Diabetic Angiopathies / Q000150:complications / Q000191:economics / Q000601:surgery*; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000191:economics / Q000601:surgery; D016903:Drug Monitoring; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
Algorithm; CABG; Diabetes mellitus; Health economics; Hyperglycemia; Surgery complications