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Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: Prospective, cohort
Francesco Nicolini1, Giuseppe Santarpino2, Giuseppe Gatti3
1Division of Cardiac Surgery, University of Parma, Parma, Italy.
Insights
Elevated glycated hemoglobin (HbA1c) levels in patients undergoing coronary artery bypass grafting (CABG) predict sternal wound infection (SWI). Preoperative HbA1c screening is valuable for identifying diabetic patients at risk of SWI.
Area of Science:
- Cardiovascular Surgery
- Metabolic Health
- Postoperative Complications
Background:
- Increased glycated hemoglobin (HbA1c) is linked to higher sternal wound infection (SWI) risk post-coronary artery bypass grafting (CABG).
- The impact of elevated HbA1c on other postoperative outcomes remains unclear.
Purpose of the Study:
- To investigate the association between preoperative HbA1c levels and various postoperative outcomes in patients undergoing elective CABG.
- To determine the predictive value of HbA1c for SWI and other complications.
Main Methods:
- Prospective, multicenter E-CABG registry data from 2606 patients undergoing elective isolated CABG (2015-2016).
- Collection and analysis of preoperative HbA1c levels.
- Multilevel mixed-effects logistic regression analysis to adjust for center-specific effects.
Main Results:
- A significant proportion of patients had elevated HbA1c (≥53 mmol/mol or 7.0%), particularly those with diabetes (53.5% non-insulin dependent, 67.1% insulin dependent).
- Baseline HbA1c ≥53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%), deep SWI/mediastinitis (3.8% vs. 1.3%), and acute kidney injury (27.4% vs. 19.8%).
- Among diabetic patients, HbA1c ≥53 mmol/mol (7.0%) predicted SWI (11.1% vs. 4.8%).
Conclusions:
- Elevated HbA1c is prevalent in CABG patients and associated with increased SWI risk.
- Preoperative HbA1c screening is recommended for identifying diabetic patients at higher risk of SWI.
- Results do not support routine HbA1c screening in non-diabetic patients undergoing CABG.
Background:
Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes.
Material And Methods:
Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry.
Results:
The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p < 0.001). The prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p < 0.001). Baseline levels of HbA1c ≥ 53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%, adjusted p-value: <0.001), deep SWI/mediastinitis (3.8% vs. 1.3%, adjusted p-value: 0.001) and acute kidney injury (27.4% vs. 19.8%, adjusted p-value: 0.042). These findings were confirmed in multilevel mixed effect logistic regression adjusted for participating centers. Among patients with diabetes, HbA1c ≥ 53 mmol/mol (7.0%) was predictive of SWI (11.1% vs. 4.8%, p = 0.001).
Conclusions:
HbA1c is increased in a significant proportion of patients undergoing elective CABG and these patients are at higher risk of SWI. Less clear is the impact of increased HbA1c on other postoperative outcomes. These results do not support screening of HbA1c in patients without history of diabetes. Preoperative screening of HbA1c is valuable only to identify diabetics at risk of SWI.
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