Diabetes mellitus and coronary artery bypass Short-term risk and long-term prognosis

Salomon, Neal W.; Page, U. Scott; Okies, J. Edward; Stephens, J. W. W.; Krause, Albert H.; Bigelow, John

doi:10.1016/s0022-5223(19)38882-8

Cited by 111 publications

(18 citation statements)

References 17 publications

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“…15 Impaired function ofneutrophil leucocytes is the other adverse effects of hyperglycaemia which leads to higher rate of postoperative infections and impaired wound healingand also contribute to increased platelet activity, alteration in coagulation physiology, fibrinolysis, lipid metabolism as well as endothelial function. [22][23][24][25][26][27][28][29][30] Consistent with the findings of our study, Zerr et al who showed that using a continuous insulin infusion protocol in perioperative period to control blood glucose results in lower rate of in-hospital mortality and morbidity. 31 It has also been shown that lowering mean blood glucose level to less than 200 mg/dL in the immediate post-operative period results in a reduced incidence of deep wound infection in diabetic patients.…”

Section: Discussionsupporting

confidence: 90%

“…17 Prior studies that evaluated postoperative complications largely focused on individual diseases and were too small to detect differences in morbidity outcomes. 3,7,22,23 Diabetic patients in our study had higher prevalence of renal failure but had slightly higher ejection fraction than non-diabetics.…”

Section: Discussionmentioning

confidence: 58%

“…Hyperglycemia interferes with the function of polymorphonuclear leukocytes predisposing to infection and may impair wound healing. [22][23][24][25][26][27] Some studies suggest a relation between improved glucose control in the peri-operative period and lower rates of wound infection and dehiscence. 31,34,35 Hyperglycaemia could also contribute to increased platelet activity and disordered coagulation and fibrinolytic functionas well as abnormalities in lipid metabolism.…”

Section: Discussionmentioning

confidence: 99%

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Early and mid-term outcome of CABG surgery in diabetic and non-diabetic patients in a tertiary care hospital in Bangladesh

Karim

Rahman

Siraj

et al. 2019

Bangladesh Med Res Counc Bull

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Background: Previous trials showed that diabetic patients had worse in-hospital and long term outcome after coronary artery bypass grafting (CABG) than non diabetic ones. However, the majority of such studies was carried out in western countries and limited information is available for the Asian population. Objective: The present study was intended to determine the impact of diabetes on early and mid-term outcome among patients undergoing CABG surgery in a tertiary care hospital in Bangladesh. Methods: This study was performed at Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh, from January to June 2014. Based on enrollment criteria, 202 patients (115 diabeticsand 87 non-diabetics) were enrolled and evaluated for their early outcome (within 30 days of operation) and midterm (after 30 days post-operatively). Patients with known diabetes or preoperative fasting blood sugar ≥6.4 mmol/L or random blood sugar ≥11.1 mmol/L were considered as diabetics. The outcome measures were ICU stay, reopening for bleeding, atrial fibrilation, cardiac arrest, total hospital stay, left ventricular ejection fraction and mortality. Results: Diabetic patients in this study had higher prevalence of hypertension, hyperlipidaemia, and renal failure. The diabetic and the non diabetic groups received a mean number of grafts of 3.2±1.06 and 2.81±1.21, respectively, Postoperative mortality in diabetic and non-diabetic patients at early and mid-term were not significantly different in univariate analysis (4.3% vs. 2.3%, p= 0.352) and (2.6 % vs. 2.3%,p = 0.630) respectively. The mean intensive care unit (ICU) stay in diabetic and non-diabetic were same (3.5days) but total hospital stay was significantly higher in the former group (one day or more). Re-opening for bleeding, atrial fibrilation and cardiac arrest in ICU were found higher in DM than those in non-DM group (28.7%vs.20.7%,10.4% vs. 8% and 4.2% vs.1.1% respectively). Conclusion: Although the mortality rate of diabetic patients following CABG surgery was in significantly higher than their non-diabetic counterparts. Morbidity was also a bit higher. Strict perioperative glyacemic control could reduce morbidity and mortality in diabetic patients undergoing CABG.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Early and mid-term outcome of CABG surgery in diabetic and non-diabetic patients in a tertiary care hospital in Bangladesh

Karim

Rahman

Siraj

et al. 2019

Bangladesh Med Res Counc Bull

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“…The maintenance of physiologic blood glucose levels is an important strategy to decrease DSWI rate. Diabetes mellitus has been established as an independent risk factor for postoperative surgical wound infection, with infection rates two to five times more prevalent than in non-diabetic population [1, 11-13, 59, 64, 71-85, 126] Diabetic patients undergoing cardiac surgical procedures, before use of IV insulin, were more likely to have worse short-and long-term survival and higher rates of DSWI [33,71,72,93,[127][128][129][130][131]. Furthermore, post-sternotomy mediastinitis in diabetic patients after cardiac surgery increases operative mortality 2-to 3-fold [34].…”

Section: Prophylactic Antibiotic Therapy Perioperative Antimicrobialmentioning

confidence: 99%

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

Abu‐Omar

Kocher

Bosco

et al. 2017

Eur J Cardiothorac Surg

159

177

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Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.

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“…Furthermore, patients with type 2 diabetes had considerable drug costs for cardiovascular and lipid lowering drugs; 2366 SEK per patient per year together. Drug costs for antidiabetic drugs constituted a rather small fraction of the overall drug cost Blindness P = 3.7%, I = 0.13% P = 12.8% [18], I = NA Dialysis P = 0.51%, I = 0% P = 0.2% a [19], I = 0.03% a [19] Foot ulcer P = 5.4%, I = 1.8% P = 3±8% [20], I = na Amputation P = 1.29%, I = 0.13% P = 2% [21], I = 0.17% [20] Myocardial infarction P = 9.4%, I = 0.64% P = NA, I = 0.65% [22] Angina P = 17.2%, I = 0.9% P = 8% b [23], I = 0.45% b [23] Coronary artery bypass graft P = 4%, I = 0% P = 11±12% a [24], I = 0.039% [25] b Stroke P = 6.8%, I = 1.16% P = 11% [21], I = 0.44% [22] NA: not applicable; a both type 1 and type 2 diabetes. b for the general population.…”

Section: Direct Medical Costsmentioning

confidence: 99%

Direct medical costs for patients with type 2 diabetes in Sweden

Henriksson

Agardh

Berne

et al. 2000

Journal of Internal Medicine

124

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. Henriksson F, Agardh C‐D, Berne C, Bolinder J, Lönnqvist F, Stenström P. Östenson C‐G, Jönsson B (Centre for Health Economics, Stockholm; Department of Endocrinology, University Hospital MAS, Malmö; Department of Internal Medicine, Uppsala University Hospital; Centre for Metabolism and Endocrinology and SmithKline Beecham Pharmaceuticals AB, Karolinska Institute; Diabetes Prevention Unit, Karolinska Hospital, Stockholm, Sweden). Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 2000; 248: 387–396. Objectives. To estimate the total direct medical costs to society for patients with type 2 diabetes in Sweden and to investigate how different factors, for example diabetic late complications, affect costs. Design. Cross‐sectional data regarding health care utilization, clinical characteristics and quality of life, were collected at a single time‐point. Data on resource use cover the 6‐month period prior to this time point. Setting. Patient recruitment and data collection were performed in nine primary care centres in three main regions in Sweden. Subjects. Only patients with an age at diabetes diagnosis ≥ 30 years (type 2 diabetes) were included (n = 777). Results. The total annual direct medical costs for the Swedish diabetes type 2 population were estimated at about 7 billion SEK (Swedish Kronor) in 1998 prices, which is about 6% of the total health care expenditures and more than four times higher than the former Swedish estimate obtained when using diabetes as main diagnosis for calculating costs. The annual per patient cost was about 25 000 SEK. The largest share of this cost was hospital inpatient care. Costs increased with diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycaemic drugs or with life style modification only. Patients with both macro‐ and microvascular complications had more than three times higher costs compared with patients without such complications. Conclusions. Type 2 diabetes is a serious and expensive disease and the key to reducing costs seems to be intensive management and control in order to prevent and delay the associated late complications.

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Diabetes mellitus and coronary artery bypass Short-term risk and long-term prognosis

Cited by 111 publications

References 17 publications

Early and mid-term outcome of CABG surgery in diabetic and non-diabetic patients in a tertiary care hospital in Bangladesh

Early and mid-term outcome of CABG surgery in diabetic and non-diabetic patients in a tertiary care hospital in Bangladesh

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

Direct medical costs for patients with type 2 diabetes in Sweden

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