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Glycosylated Hemoglobin (HbA1C) as a Predictor of Early Postoperative Outcomes After Coronary Artery Bypass Grafting:
Fahad M Alshair1, Abdullah H Baghaffar2,1, Mazin A Fatani2,1
1Cardiac Surgery, King Abdulaziz University Hospital, Jeddah, SAU.
Insights
Elevated glycosylated hemoglobin (HbA1c) does not predict postoperative complications in coronary artery bypass grafting (CABG) patients. Surgery can proceed without delay, even with high HbA1c levels, optimizing patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Clinical Chemistry
Background:
- Diabetic patients constitute a significant portion of surgical revascularization candidates.
- Hyperglycemia is linked to increased adverse surgical events.
- Glycosylated hemoglobin (HbA1c) serves as a key marker for long-term glycemic control and is increasingly used to predict outcomes.
Purpose of the Study:
- To evaluate the impact of elevated HbA1c on the incidence of postoperative complications following coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective review of medical records for adult patients undergoing isolated CABG from January 2015 to December 2022.
- Assessment of patient demographics, medications, laboratory results, HbA1c levels, and clinical data.
- Statistical models were developed to identify predictors of postoperative complications.
Main Results:
- The study included 289 adult patients who underwent on-pump CABG.
- Uncontrolled HbA1c was more prevalent in females and hemodialysis patients.
- No significant differences in the incidence of postoperative complications (infection, blood transfusion, heart failure, arrhythmia, death) were observed across different HbA1c levels.
- Multivariate and stepwise analyses indicated that HbA1c had no predictive value for postoperative complications.
Conclusions:
- Elevated preoperative HbA1c did not predict early complications or intermediate postoperative outcomes in this cohort.
- The findings suggest that CABG surgery can proceed without delay in patients with elevated HbA1c.
- Optimizing preoperative glycemic control may be considered for elective patients with low-risk profiles.
Abstract:
Background Diabetic patients present a majority of patients undergoing surgical revascularization. Hyperglycemia is associated with increased adverse events. Glycosylated hemoglobin (HbA1c) is an effective biological marker for long-term glycemic control. As a result, there is an increased trend in its use as a predictor of adverse outcomes. This study aims to assess the impact of elevated HbA1c on the occurrence of postoperative complications after coronary artery bypass grafting (CABG). Methods We conducted a retrospective review of medical records from January 2015 to December 2022 for adult patients who underwent isolated CABG. We assessed patient demographics, medication, laboratory results, HbA1c results, and clinical data. The separate statistical models were designed to assess the predictors for the development of postoperative complications. Results This retrospective single-center study was conducted on 289 consecutive adult patients who underwent on-pump CABG. Patient demographics showed that uncontrolled HbA1c was more in females (p=0.022), and hemodialysis patients (p=0.018). Across different levels of HbA1C, there were no significant differences in terms of the incidence of postoperative complications (p=0.788 for infection, p=0.372 for the need for blood transfusion, p=0.721 for heart failure, p=0.692 for arrhythmia, and p=0.712 for death). HbA1c had no predictive value for postoperative complications as indicated by multivariate and stepwise analysis in a separate model for each complication with receiver operator characteristics curves of each model showing similar strength of both multivariate and stepwise models. Conclusions In our data, elevated preoperative HbA1c had no predictive value for early complications and intermediate postoperative outcomes. We recommend that surgery should proceed without delay, even if patients have elevated HbA1C levels. As for elective patients with low-risk features and anatomy, optimizing preoperative glycemic control can be considered.
