Cardiac Surgery Outcomes May Be Tied to Glucose Levels

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Hyperglycemia is associated with worse outcomes for patients without diabetes, but better outcomes for those with diabetes.
Hyperglycemia is associated with worse outcomes for patients without diabetes, but better outcomes for those with diabetes.

(HealthDay News) — For patients undergoing cardiac surgery, hyperglycemia is associated with worse outcomes for patients without diabetes, but with better outcomes for patients with insulin-treated diabetes, according to a study published in Diabetes Care.

Giampaolo Greco, PhD, from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a multicenter cohort study in 4316 cardiac surgery patients who underwent surgery in 2010. Glucose was measured every 6 hours for 48 hours postoperatively. The researchers examined the correlations between maximum glucose levels and outcomes, including cost, hospital length of stay, and cardiac and respiratory complications.

The researchers found that increasing glucose levels correlated with a gradual worsening of outcomes among patients without diabetes. Hyperglycemia, defined as 180 mg/dL or greater, correlated with an additional cost of $3192, an additional hospital length of stay of 0.8 days, a 1.6% increase in infections, and a 2.6% increase in respiratory complications. 

Optimal outcomes correlated with glucose levels of 180 mg/dL to 240 mg/dL for patients with insulin-treated diabetes. This level of hyperglycemia correlated with cost reductions of $6225, a 1.6-day reduction in hospital length of stay, a 4.1% reduction in infections, and a 12.5% reduction in respiratory complications. 

Outcomes did not differ significantly when hyperglycemia was present for patients with non-insulin-treated diabetes.

"These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status," the researchers wrote.

One researcher disclosed financial ties to the pharmaceutical and medical device industries.

Reference

  1. Greco G, Ferket BS, D'Alessandro DA, et al. Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery. Diabetes Care. 2016;doi:10.2337/dc15-1817.
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