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Published on: March 27, 2018
Effect of glycaemic control on coronary artery bypass grafting outcomes - a United Kingdom centre experience
Manoraj Navaratnarajah1, Fadi Ibrahim Al-Zubaidi1, Hassan Kattach1
1Department of Cardiac Surgery, Southampton University Hospital, Southampton, UK.
Insights
Pre-operative HbA1c levels predict adverse outcomes in diabetes patients undergoing coronary artery bypass grafting (CABG). Elevated HbA1c indicates higher risks for mortality, infection, and prolonged recovery after CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Endocrinology
- Diabetology
Background:
- Diabetes mellitus is a significant comorbidity affecting cardiovascular health.
- Coronary artery bypass grafting (CABG) outcomes can be influenced by patient-specific factors.
- Glycemic control, indicated by HbA1c, is crucial in managing diabetes complications.
Purpose of the Study:
- To evaluate the predictive value of pre-operative HbA1c for outcomes in diabetes patients after CABG.
- To assess the impact of diabetes on morbidity and mortality following CABG.
- To determine if HbA1c levels correlate with specific adverse events post-CABG.
Main Methods:
- Retrospective analysis of patient data following CABG.
- Comparison of outcomes between diabetes patients and non-diabetes patients.
- Statistical examination of the relationship between pre-operative HbA1c levels and post-CABG complications.
Main Results:
- Diabetes patients experienced prolonged length of stay (LOS) and increased rates of wound infection, pneumonia, and new-onset atrial fibrillation post-CABG.
- Elevated HbA1c demonstrated a significant positive predictive value for long-term mortality, pneumonia, blood transfusion requirements, and wound infections.
- Pre-operative HbA1c was an independent predictor of long-term mortality, superficial wound infection, and delayed discharge.
Conclusions:
- Diabetes is associated with increased morbidity and prolonged LOS after CABG.
- Pre-operative HbA1c is a valuable predictor of adverse outcomes, including morbidity and mortality, in diabetes patients undergoing CABG.
- Routine pre-operative HbA1c screening is recommended for all surgical patients to identify those at higher risk.
Objectives:
Assess whether pre-operative HbA1c demonstrates positive predictive value relating to outcomes following coronary artery bypass grafting (CABG) in diabetes patients.
Methods:
Retrospective analysis of outcomes and mortality following CABG; examining the effects of diabetes and HbA1c.
Results:
Post-operative length of stay (LOS) was prolonged in elective and urgent diabetes patients;7.3 ± 2.1 versus 6.4 ± 1.6 days and 9.0 ± 1.9 versus 7.6 ± 1.8 days, respectively; (p < 0.001). Sternal and leg wound infection rate was higher in elective diabetes group compared to no-diabetes group; 7% versus 3% (p < 0.01) and 3% versus 1% (p < 0.05), respectively. Pneumonia rate increased in elective and urgent diabetes patients; 19% versus 8% (p < 0.001) and 21% versus 15% (p < 0.05), respectively. Diabetes increased new-onset atrial fibrillation; 26% versus 14% (p < 0.001), and doubled blood transfusion rate; 28% versus 14% (p < 0.001) in elective patients; with similar findings in urgent patients. Long-term mortality was higher with diabetes compared to no-diabetes in elective patients; 15% versus 5%, (p < 0.001), and urgent patients; 10% versus 2%, (p < 0.001). Elevated HbA1c showed significant positive predictive value relating to long-term mortality, and rates of pneumonia, blood transfusion, wound infection in elective and urgent diabetes patients; (p < 0.001). Elevated HbA1c was an independent predictor of long-term mortality (hazard ratio:5.27, 95% CI:2.53-10.99; p < 0.001), superficial wound infection (odds ratio (OR):18.23, p < 0.001) and delayed discharge (OR:8.15, p < 0.001).
Conclusions:
Diabetes patients have prolonged LOS and increased morbidity following CABG. HbA1c is predictive of morbidity and long-term mortality in diabetes patients, and pre-operative HbA1c screening is justified in all surgical patients.
