Elevated Preoperative Hemoglobin A1c Level is Associated With Reduced Long-Term Survival After Coronary Artery Bypass Surgery

Halkos, Michael E.; Lattouf, Omar M.; Puskas, John D.; Kilgo, Patrick D.; Cooper, William A.; Morris, Cullen D.; Guyton, Robert A.; Thourani, Vinod H.

doi:10.1016/j.athoracsur.2008.06.078

Cited by 174 publications

(132 citation statements)

References 19 publications

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“…7,15,16,20 HbA1c levels exceeded 6.0% in 31% (n = 456) of the study cohort ( Figure 1A). Compared with the normal group, patients with HbA1c [ 6.0% were heavier (90 ± 22 vs 84 ± 21 kg; P \ 0.0001), more likely to be obese (body mass index [BMI] 30.1 ± 7.7 vs 28.1 ± 6.4 kgÁm -2 ; P \ 0.0001), and more likely to be Caucasian than African American (88 vs 77%; P \ 0.0001).…”

Section: Resultsmentioning

confidence: 99%

“…29,31 Other long-term studies involving both diabetics and non-diabetics correlate elevated HbA1c with poorer survival both in the general population 32 and specifically following cardiac surgery. 15 In a cohort of over 3,000 diabetic and non-diabetic, onpump and off-pump aortocoronary bypass surgery patients, Halkos et al reported an association between elevated HbA1c and several short-term adverse outcomes, including postoperative myocardial infarction, deep sternal wound infection, renal failure, stroke, and short-term mortality. 16 A similar but smaller study by Medhi et al noted HbA1c and non-diabetic heart surgery outcome 569 prolonged hospital stays after aortocoronary bypass surgery in patients with elevated preoperative HbA1c levels.…”

Section: Discussionmentioning

confidence: 99%

“…In diabetics requiring cardiac surgery, lower HbA1c levels correlate with lower adverse event rates and 30-day mortality risk. 15,16 Although the role of HbA1c as a marker of complication risk is established for diabetics, studies exploring its value in non-diabetics are limited. 17,18 Thirty percent of non-diabetics undergoing percutaneous coronary interventions have elevated HbA1c levels, and these patients are at higher risk of cardiac mortality and adverse events.…”

Section: Rèsumèmentioning

confidence: 99%

See 2 more Smart Citations

Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients

Hudson

Welsby

Phillips-Bute

et al. 2010

Can J Anesth/J Can Anesth

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Rèsumèmentioning

confidence: 99%

See 1 more Smart Citation

Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients

Hudson

Welsby

Phillips-Bute

et al. 2010

Can J Anesth/J Can Anesth

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“…One study of nearly five hundred patients showed an A1C less than 7% was significantly associated with lower infections after non-cardiac surgery, which included pneumonia, wound infections, urinary infections, or systemic infections [13]. A similar A1C cutoff was observed in patients with diabetes undergoing bypass surgery, as an A1C greater than or equal to 7% was associated with a reduced five-year survival [14] and increased unfavorable events, including renal failure, stroke, and surgical wound infection [15].…”

Section: Preoperative Glycemic Control Hemoglobin A1c (A1c)mentioning

confidence: 77%

Preoperative Glycemic Control for Adult Diabetic Patients Undergoing Elective Surgery

Weir¹,

Deeb²

2016

PLAID

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As the prevalence of diabetes continues to increase in the United States, a higher proportion of elective surgical candidates will require specific preoperative education and guidelines to maximize patient outcomes and reduce the costs of care. The purpose of this article is to review the current literature to determine how preoperative glycemic control affects the lengths of hospital stays, postoperative complications, and mortality in people living with type 1 and 2 diabetes. Additional recommendations are provided for preoperative hypo-and hyperglycemia, the use of insulin pumps or continuous glucose monitors, and day-of-surgery management of insulin and oral hypoglycemic agents. Gaps in medical evidence are acknowledged and future directions in research are proposed to provide high-quality guidelines for the preoperative care of adult patients with diabetes.

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“…For each unit increase in HbA1c, there was a significantly increased risk of myocardial infarction and deep sternal wound infection. Halkos et al [18] also investigated longterm outcomes. Their results show a significant reduction in longterm survival (OR 1.15, P<0.001) per unit increase in HbA1c ≥7%.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Hba1c level in prediction of short-term morbidity and mortality outcomes following coronary artery bypass grafting surgery

Arslan¹,

Memetoğlu²,

Kutlu³

et al. 2015

RusOMJ

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Abstract:Objective -This study was conducted to determine whether HbA1c is a predictor of short term mortality and morbidity after coronary artery bypass graft operation. Methods -The coronary artery bypass graft operation was performed on the patients between January 2009 and January 2013. Each patient's medical record was retrospectively reviewed. The patients who were included in the study were evaluated in groups of 60. One group was comprised of nondiabetic patients, whose HbA1c level is below 6% (the control group 0), the other included diabetic patients with the HbA1c level is between 6-6.9% (the group 1) and the last group, group 2, included those patients with HbA1c level is equal or greater than 7%. Pre, peri and post operation data was compared. The deaths that occured in the first 30 days were evaluated as mortality and complications as morbitity. Results -While mortality was not observed in the control group, one incident was observed in group 1 and 5 in group 2, which corresponds to 1.7% and 8.3% respectively. The mortality ratio in the group with patients whose HbA1c was greater or equal to 7% found statistically significant compared to the control group (P=0.02). The following parameters were observed in group 2 and were found statistically significant: the need for dialisis (25%, P<0.01), atrial fibrillation (33%, P=0.01), revision due to bleeding (10%, P=0.18), cerebrovascular event (16,7%, P=0.01), duration of mechanic ventilation (19.5±21.6, P=0.06), duration of hospital stay (approximately 9.91±5.35 days, P=0.01), infection in scar (53%, P<0.01), mediastenit (11%, P=0.01) and urinary tract infection (10%, P=0.01) Conclusion -We concluded that in those diabetic patients that elective coronart artery bypass graft is applied, highly reactive HbA1c levels (HbA1c ≥7), may indicate morbitity in the early stages of post operation.

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Elevated Preoperative Hemoglobin A1c Level is Associated With Reduced Long-Term Survival After Coronary Artery Bypass Surgery

Cited by 174 publications

References 19 publications

Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients

Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients

Preoperative Glycemic Control for Adult Diabetic Patients Undergoing Elective Surgery

Preoperative Hba1c level in prediction of short-term morbidity and mortality outcomes following coronary artery bypass grafting surgery

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