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Glycemic control in patients undergoing coronary artery bypass graft surgery: Clinical features, predictors, and

Judson B Williams1, Eric D Peterson2, Álvaro S Albrecht3

  • 1Duke Clinical Research Institute, Durham, NC, United States; Department of Surgery, Duke University School of Medicine, Durham, NC, United States; WakeMed Clinical Research Institute, WakeMed Health and Hospitals, Raleigh, NC, United States.

Journal of Critical Care
|September 23, 2017
PubMed

Insights

Good glycemic control after high-risk cardiac surgery is linked to better outcomes but is achieved in only 15% of patients. Hospital performance in managing blood sugar varies significantly, impacting patient prognosis.

Area of Science:

  • Cardiology
  • Endocrinology
  • Critical Care Medicine

Background:

  • Hyperglycemia in critically ill patients is associated with poorer prognosis.
  • The impact of glycemic control on outcomes after Coronary Artery Bypass Graft (CABG) surgery is not well-established.

Purpose of the Study:

  • To evaluate the achievement of glycemic control in the perioperative period following high-risk CABG surgery.
  • To determine the association between glycemic control and clinical outcomes, including mortality and major complications.

Main Methods:

  • A study involving 2032 patients undergoing high-risk CABG across 55 US hospitals.
  • Good glycemic control defined as blood sugar (BS) between 70-180 mg/dL within 24 hours post-surgery.
  • Generalized estimating equations logistic regression models were used for analysis, adjusting for baseline characteristics.

Main Results:

  • Only 15% of patients achieved good glycemic control (70-180 mg/dL).
  • Patients with good glycemic control had significantly lower rates of mortality and major complications (OR=0.66; p=0.02).
  • Hypoglycemic events occurred in 12% of patients, with wide hospital variation (2%-58%), unrelated to overall good glucose control rates.

Conclusions:

  • Achieving perioperative glycemic control in high-risk CABG patients is associated with reduced mortality and morbidity.
  • Good glycemic control was achieved in only 15% of patients, indicating a significant gap in care.
  • There was considerable variation among hospitals in their ability to achieve target glycemic control.
Abstract

Keywords:
Clinical outcomesCoronary artery bypass graft surgeryHyperglycemiaHypoglycemiaIntensive care unitPerioperative care

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