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Perioperative morbidity in diabetics requiring coronary artery bypass surgery
R Clement1, J A Rousou, R M Engelman
1Baystate Medical Center, Springfield, MA 01107.
Insights
Diabetes mellitus patients undergoing coronary artery bypass surgery showed similar complication rates to nondiabetic patients. However, diabetic patients experienced longer hospital stays, with intraaortic balloon use increasing complications.
Area of Science:
- Cardiology
- Diabetology
- Surgical Outcomes
Background:
- Coronary artery disease (CAD) is a leading cause of mortality globally.
- Diabetes mellitus is a significant risk factor for CAD and may impact surgical outcomes.
- Understanding the specific risks associated with CAD surgery in diabetic patients is crucial for patient management.
Purpose of the Study:
- To compare the operative results of coronary artery bypass grafting (CABG) between diabetic and nondiabetic patients.
- To identify preoperative and intraoperative factors influencing outcomes in diabetic patients undergoing CABG.
- To assess the impact of diabetes on perioperative morbidity and hospital stay after CABG.
Main Methods:
- Retrospective analysis of 384 diabetic patients and 396 matched nondiabetic patients undergoing CABG over a six-year period.
- Evaluation of 13 preoperative and 5 intraoperative variables.
- Comparison of perioperative complications including myocardial infarction, renal failure, neurological sequelae, infections, and thromboembolic events.
Main Results:
- Diabetic patients had a higher incidence of hypertension and a lower proportion of males compared to nondiabetic patients.
- No significant difference was observed in the incidence of major perioperative complications (myocardial infarction, renal failure, neurological sequelae, infections, thromboembolic events) between the groups.
- Diabetic patients experienced significantly longer hospital stays.
- Intra-aortic balloon counterpulsation use was associated with higher postoperative complications in diabetic patients compared to diabetics without support.
Conclusions:
- Diabetes mellitus, per se, does not significantly increase morbidity following coronary artery bypass surgery.
- While overall complication rates are similar, diabetic patients may require longer hospitalization.
- Careful patient selection and management, especially concerning the use of mechanical circulatory support, are important for optimizing outcomes in diabetic patients undergoing CABG.
Abstract:
We retrospectively evaluated the operative results in 384 patients with diabetes mellitus operated on for ischemic coronary artery disease over a six-year period compared with a random group of 396 patients selected from 2,069 nondiabetic patients who underwent operation during the same study period. In our analysis of 13 preoperative and 5 intraoperative variables, diabetics revealed a significantly increased incidence of hypertension (p less than 0.05) and a smaller proportion of men (p less than 0.05). All other variables were not significantly different. The incidence of perioperative myocardial infarction, renal failure, neurological sequelae, leg infections, or thromboembolic events was similar in diabetic and nondiabetic patients. Hospital stay, however, was significantly increased in the diabetic group (p less than 0.05). The diabetic patients requiring intraaortic balloon counterpulsation had a significantly higher incidence of all postoperative complications analyzed compared with diabetics without balloon support (p less than 0.01), whereas the nondiabetic subset requiring intraaortic balloon counterpulsation exhibited only a significantly higher incidence of renal failure (p less than 0.01) and neurological complications (p less than 0.05). These results indicate that diabetes per se does not significantly increase morbidity in coronary bypass surgery.