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Diabetes Care. 2016 Mar;39(3):408-17. doi: 10.2337/dc15-1817. Epub 2016 Jan 19.

Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery.

Author information

1
International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY giampaolo.greco@mountsinai.org.
2
International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
3
Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.
4
Department of Cardiothoracic Surgery, NIH Heart Center at Suburban Hospital, Bethesda, MD.
5
Icahn School of Medicine at Mount Sinai, New York, NY.
6
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
7
Department of Cardiothoracic Surgery, Emory University Hospital Midtown, Atlanta, GA.
8
Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC.
9
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH.
10
Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
11
Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
12
University HealthSystem Consortium, Chicago, IL.
13
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.

Abstract

OBJECTIVE:

The management of postoperative hyperglycemia is controversial and generally does not take into account pre-existing diabetes. We analyzed clinical and economic outcomes associated with postoperative hyperglycemia in cardiac surgery patients, stratifying by diabetes status.

RESEARCH DESIGN AND METHODS:

Multicenter cohort study in 4,316 cardiac surgery patients operated on in 2010. Glucose was measured at 6-h intervals for 48 h postoperatively. Outcomes included cost, hospital length of stay (LOS), cardiac and respiratory complications, major infections, and death. Associations between maximum glucose levels and outcomes were assessed with multivariable regression and recycled prediction analyses.

RESULTS:

In patients without diabetes, increasing glucose levels were associated with a gradual worsening of outcomes. In these patients, hyperglycemia (≥180 mg/dL) was associated with an additional cost of $3,192 (95% CI 1,972 to 4,456), an additional hospital LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to 2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3). However, among patients with insulin-treated diabetes, optimal outcomes were associated with glucose levels considered to be hyperglycemic (180 to 240 mg/dL). This level of hyperglycemia was associated with cost reductions of $6,225 (-12,886 to -222), hospital LOS reductions of 1.6 days (-3.7 to 0.4), infection reductions of 4.1% (-9.1 to 0.0), and reductions in respiratory complication of 12.5% (-22.4 to -3.0). In patients with non-insulin-treated diabetes, outcomes did not differ significantly when hyperglycemia was present.

CONCLUSIONS:

Glucose levels <180 mg/dL are associated with better outcomes in most patients, but worse outcomes in patients with diabetes with a history of prior insulin use. These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status.

PMID:
26786574
PMCID:
PMC4764032
[Available on 2017-03-01]
DOI:
10.2337/dc15-1817
[Indexed for MEDLINE]
Free PMC Article

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