Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting

Estrada, Carlos A.; Young, James A.; Nifong, L. Wiley; Chitwood, W. Randolph

doi:10.1016/s0003-4975(02)04997-4

Cited by 236 publications

(143 citation statements)

References 19 publications

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“…Increasing evidence from observational and prospective interventional studies has shown that inpatient hyperglycemia is a predictor of poor clinical outcome of adult subjects. [3][4][5][6][7][8][9][10][11][12][13]16,17 Admission hyperglycemia has been associated with increased morbidity and mortality in patients with critical illness, as well as in non-critically ill adult subjects admitted to general surgical and medical wards. 3,6,18 In this study we also found that hyperglycemia is a common finding in children admitted with critical and noncritical illnesses and that most children had no history of diabetes before admission.…”

Section: Discussionmentioning

confidence: 99%

“…Extensive evidence from observational studies indicates that hyperglycemia in patients with or without a history of diabetes is an important marker of poor clinical outcome. [3][4][5][6][7][8][9][10][11][12] Several prospective randomized trials in patients with critical illness have shown that aggressive glycemic control improves short-and long-term mortality, multiorgan failure and systemic infection, and length of hospitalization. [13][14][15][16][17] The importance of glucose control also applies to adult patients admitted to general surgical and medical wards.…”

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confidence: 99%

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Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital.METHODS:The study was a retrospective observational cohort of pediatric patients admitted to a community children's hospital from January 2004 to August 2004. Medical records of 903 consecutive children admitted to critical and non–critical care areas were reviewed. Of them, 342 patients (38%) had no blood glucose measurements during their hospital stay. In the remaining patients, we determined the prevalence of hyperglycemia and examined the association of hyperglycemia with clinical outcome.RESULTS:A total of 406 patients (75%) had an admission blood glucose ≤120 mg/dL (mean ± SEM 98 ± 1 mg/dL), 103 children (19%) had an admission blood glucose level of 121–179 mg/dL (mean 143 ± 2 mg/dL), and 32 patients (5.9%) had a blood glucose level ≥180 mg/dL (mean 260 ± 18 mg/dL). Seventeen patients (13%) had a known history of diabetes prior to admission. Children with hyperglycemia were more likely to be admitted to the ICU (P < .001) and had a longer length of ICU stay (P < .001), but admission hyperglycemia was not associated with longer hospital stay or higher hospital mortality.CONCLUSIONS:Hyperglycemia is present in one‐fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. Hyperglycemia was associated with a greater need for ICU care and longer ICU stay but not with increased in‐hospital mortality. Journal of Hospital Medicine 2008;3:212–217. © 2008 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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“…Diabetic and nondiabetic patients with hyperglycemia have more complications, resulting in a longer hospital length of stay (LOS) and higher costs (6,7). In a retrospective analysis of cardiothoracic surgery patients with and without diabetes, each 50 mg/dl increase in glucose was associated with 0.76 more postoperative days, $2,824 more inpatient hospital charges, and $1,769 more inpatient hospital costs (6). In stroke patients, hyperglycemia Ͼ130 mg/dl on admission was related to a 1-day longer LOS and $1,349 higher inpatient hospital charges (7).…”

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confidence: 99%

“…Thus far, five of the nine ICUs have received the TRIUMPH intervention including the medical intensive care, coronary care, and cardiothoracic surgery units. These units were chosen on the basis of previously published benefits in these patient populations (1)(2)(3)(4)(5)(6). Medical directors of these units were offered the intervention, and all of them willingly participated.…”

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confidence: 99%

Economic Benefits of Intensive Insulin Therapy in Critically Ill Patients

Sadhu¹,

Ang²,

Ingram‐Drake³

et al. 2008

Diabetes Care

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OBJECTIVE -The purpose of this study was to analyze the economic outcomes of a clinical program implemented to achieve strict glycemic control with intensive insulin therapy in patients admitted to the intensive care unit (ICU). RESEARCH DESIGN AND METHODS-A difference-in-differences (quasiexperimental) study design was used to examine the associations of an intensive insulin therapy intervention with changes in hospital length of stay (ICU and total), costs (ICU and total), and mortality. Hospital administrative data were obtained for 6,719 adult patients admitted between 2003 and 2005 to one of five intervention or four comparison ICUs in a large academic medical center. Linear regression models with log transformations and appropriate retransformations were used to estimate length of stay (LOS) and costs; logistic regressions were used to estimate mortality.RESULTS -After adjustment for observable patient characteristics and secular time trends, the intervention was consistently associated with lower average glucose levels and a trend toward shorter LOS, lower costs, and lower mortality. However, associations with resource use and outcomes were statistically significant in only ICU LOS, with an average reduction of 1.19 days of ICU care per admission. Other associations, although large in magnitude and in the hypothesized directions, were not estimated with sufficient precision to rule out other net effects. The associations with ICU days and costs were larger in magnitude than total days and costs.CONCLUSIONS -A clinical team focused on hyperglycemia management for ICU patients can be a valuable investment with significant economic benefits for hospitals.

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“…Hyperglycemia itself has been shown to contribute to increasing hospital length of stay (LOS) and overall cost. Investigators have shown that for each 50-mg/dl increase in blood glucose level in patients with diabetes undergoing a coronary artery bypass grafting procedure, there was an additional 0.76-day LOS (an incremental hospital cost of $2,824) (28). Hyperglycemia is an independent predictor of hospital LOS in trauma patients (29).…”

Section: Data Derived From Patients With Acute MImentioning

confidence: 99%

American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control

Diabetes¹

2006

Diabetes Care

203

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Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting

Cited by 236 publications

References 19 publications

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Economic Benefits of Intensive Insulin Therapy in Critically Ill Patients

American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control

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