Value of postoperative blood glucose in predicting complications and length of stay after coronary artery bypass grafting

Fish, Lisa H.; Weaver, Todd; Moore, Ann M.; Steel, Laraine G.

doi:10.1016/s0002-9149(03)00472-7

Cited by 62 publications

(32 citation statements)

References 8 publications

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“…Estrada, Fish, Furnary and their co-workers demonstrated that controlling blood glucose levels at values lower than 200 mg/dl in diabetic patients leads to significantly fewer postoperative complications, including in-hospital death [17][18][19]. During the 10-year study interval in our series, we aimed at maintaining the blood glucose levels between 120 and 160 mg/dl in diabetic patients, and below 180 mg/dl in non-diabetic patients, during the perioperative period.…”

Section: Discussionmentioning

confidence: 98%

Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

Antunes

Oliveira

Antunes

2008

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 98%

Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

Antunes

Oliveira

Antunes

2008

European Journal of Cardio-Thoracic Surgery

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“…Postoperative SG level also impacts the outcome in patients undergoing CABG surgery. In a retrospective study of 200 patients who underwent CABG surgery, Fish et al (9), using a postoperative blood glucose cut-off level of 11.1 mmol/L to identify diabetes, reported a threefold increase in complications associated with hyper glycemia. In another study of 878 previously nondiabetic patients undergoing CABG surgery, Zindrou et al (12) reported that in women, an admission SG level of greater than 6 mmol/L was predictive of increased 30-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Impact of admission serum glucose level on in-hospital outcomes following coronary artery bypass grafting surgery

Imran¹,

Ransom²,

Buth

et al. 2010

Canadian Journal of Cardiology

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I t has been confirmed that serum glucose (SG) levels are independently associated with both short-and long-term outcomes of patients with cardiovascular disease (1). In the setting of an acute myocardial infarction, hyperglycemia enhances the risk of morbidity and mortality independent of the patients' diabetes status (2). Hyperglycemia is also highly predictive of the occurrence of left ventricular failure and cardiac death in patients with acute coronary syndrome (3,4), and is associated with larger infarct size, worse functional recovery and higher long-term mortality in patients undergoing reperfusion with either thrombolysis or percutaneous coronary intervention (5,6).In patients undergoing cardiac surgery, there is also evidence that both intraoperative (7,8) and postoperative (9) SG levels predict the occurrence of adverse postoperative events. Tight control of intra-and postoperative SG levels with insulin increases survival and decreases the incidence of ischemic events in diabetic patients undergoing coronary artery bypass grafting (CABG) surgery (10).In contrast to the known importance of intra-and/or postoperative SG levels on the outcomes of CABG surgery, there exists a paucity of data regarding the potential impact of preoperative or admission SG level on the outcomes of cardiac surgery. We hypothesized that an elevated preoperative or admission SG level would be an independent clInIcal studIes ©2010 Pulsus Group Inc. All rights reserved OBJECTIVE:The impact of admission serum glucose (SG) level on outcomes in coronary artery bypass grafting (CABG) surgery is unknown. The present study sought to determine whether elevated admission SG level is associated with adverse outcomes following CABG surgery. METHODS: Patients undergoing CABG surgery between January 2000and December 2005 at a single centre were identified (n=2856). Admission SG levels of less than 9.2 mmol/L and 9.2 mmol/L or greater were chosen to divide patients into two groups based on the 75th percentile of SG distribution. A logistic regression model was generated to determine the impact of admission SG level on a composite outcome of any one or more of in-hospital mortality, stroke, perioperative myocardial infarction, sepsis, deep sternal wound infection, renal failure, requirement for postoperative inotropes and prolonged ventilation. RESULTS: In total, 76.3% of patients had an admission SG level of less than 9.2 mmol/L (group A) and 23.7% had an admission SG level of 9.2 mmol/L or greater (group B). Group B patients were more likely to be female, have diabetes, have preoperative renal failure, have an ejection fraction of less than 40%, experience myocardial infarction within 21 days before surgery, and have triple vessel or left main disease (P<0.05). Univariate analysis revealed no difference in in-hospital mortality between group A (2.2%) and group B (3.2%) (P=0.12); however, the composite outcome was more likely to occur in group B (40.8%) versus group A (27.9%) (P=0.0001). After multivariable adjustment, admission SG level of...

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“…3 This is important since in other studies of the effect of peri-operative blood glucose control, follow-up time varied, was often short [17][18][19] or was not defined at all. [10][11][12][13][20][21][22] The definitions of SWI also varied from a clear CDC definition 10,13,17,20 to a modified CDC definition. 22 However, in some studies, SWIs were not separated from other nosocomial infections or were included in a general adverse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…22 However, in some studies, SWIs were not separated from other nosocomial infections or were included in a general adverse outcome. 11,18,19,21 In an infection control evaluation, it is important to have a clear definition of SWI and a follow-up sufficient to detect all SWIs in order to correctly identify risk factors. In view of the fact that risk factors may be different for SWIs with early or late onset, extended follow-up is of particular importance.…”

Section: Discussionmentioning

confidence: 99%

Peri-operative glucose control and development of surgical wound infections in patients undergoing coronary artery bypass graft

Swenne

Lindholm

Borowiec

et al. 2005

Journal of Hospital Infection

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Value of postoperative blood glucose in predicting complications and length of stay after coronary artery bypass grafting

Cited by 62 publications

References 8 publications

Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

Impact of admission serum glucose level on in-hospital outcomes following coronary artery bypass grafting surgery

Peri-operative glucose control and development of surgical wound infections in patients undergoing coronary artery bypass graft

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