Perioperative Morbidity in Diabetics Requiring Coronary Artery Bypass Surgery

Clement, Ronald; Rousou, John A.; Engelman, Richard M.; Breyer, Robert H.

doi:10.1016/s0003-4975(10)65935-8

Cited by 31 publications

(9 citation statements)

References 12 publications

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“…However, diabetes was not associated with an increased risk for in‐hospital mortality or major complications in patients undergoing coronary artery bypass grafting at our center. This is concordant to previous studies of other groups 7–10 but in contrast to Cohen who found a twofold increase in mortality in diabetic patients 11 . (Table 4) In contrast to results published in BARI trial, we did not observe an increased incidence of perioperative myocardial infarction 7 .…”

Section: Resultssupporting

confidence: 92%

“…(Table 4) In contrast to results published in BARI trial, we did not observe an increased incidence of perioperative myocardial infarction 7 . The incidence of wound infection was increased in diabetic patients in our study as well in other studies 9 , 12,13 . There was no evidence in our study that inadequate control of hyperglycemia resulted in a higher wound infection rate.…”

Section: Resultscontrasting

confidence: 82%

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Coronary Artery Bypass Surgery in Diabetic Patients

Brandt

Harder

Walluscheck

et al. 2004

Journal of Cardiac Surgery

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Section: Resultssupporting

confidence: 92%

Section: Resultscontrasting

confidence: 82%

Coronary Artery Bypass Surgery in Diabetic Patients

Brandt

Harder

Walluscheck

et al. 2004

Journal of Cardiac Surgery

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“…15 Impaired function ofneutrophil leucocytes is the other adverse effects of hyperglycaemia which leads to higher rate of postoperative infections and impaired wound healingand also contribute to increased platelet activity, alteration in coagulation physiology, fibrinolysis, lipid metabolism as well as endothelial function. [22][23][24][25][26][27][28][29][30] Consistent with the findings of our study, Zerr et al who showed that using a continuous insulin infusion protocol in perioperative period to control blood glucose results in lower rate of in-hospital mortality and morbidity. 31 It has also been shown that lowering mean blood glucose level to less than 200 mg/dL in the immediate post-operative period results in a reduced incidence of deep wound infection in diabetic patients.…”

Section: Discussionsupporting

confidence: 91%

“…Hyperglycemia interferes with the function of polymorphonuclear leukocytes predisposing to infection and may impair wound healing. [22][23][24][25][26][27] Some studies suggest a relation between improved glucose control in the peri-operative period and lower rates of wound infection and dehiscence. 31,34,35 Hyperglycaemia could also contribute to increased platelet activity and disordered coagulation and fibrinolytic functionas well as abnormalities in lipid metabolism.…”

Section: Discussionmentioning

confidence: 99%

Early and mid-term outcome of CABG surgery in diabetic and non-diabetic patients in a tertiary care hospital in Bangladesh

Karim

Rahman

Siraj

et al. 2019

Bangladesh Med Res Counc Bull

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Background: Previous trials showed that diabetic patients had worse in-hospital and long term outcome after coronary artery bypass grafting (CABG) than non diabetic ones. However, the majority of such studies was carried out in western countries and limited information is available for the Asian population. Objective: The present study was intended to determine the impact of diabetes on early and mid-term outcome among patients undergoing CABG surgery in a tertiary care hospital in Bangladesh. Methods: This study was performed at Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh, from January to June 2014. Based on enrollment criteria, 202 patients (115 diabeticsand 87 non-diabetics) were enrolled and evaluated for their early outcome (within 30 days of operation) and midterm (after 30 days post-operatively). Patients with known diabetes or preoperative fasting blood sugar ≥6.4 mmol/L or random blood sugar ≥11.1 mmol/L were considered as diabetics. The outcome measures were ICU stay, reopening for bleeding, atrial fibrilation, cardiac arrest, total hospital stay, left ventricular ejection fraction and mortality. Results: Diabetic patients in this study had higher prevalence of hypertension, hyperlipidaemia, and renal failure. The diabetic and the non diabetic groups received a mean number of grafts of 3.2±1.06 and 2.81±1.21, respectively, Postoperative mortality in diabetic and non-diabetic patients at early and mid-term were not significantly different in univariate analysis (4.3% vs. 2.3%, p= 0.352) and (2.6 % vs. 2.3%,p = 0.630) respectively. The mean intensive care unit (ICU) stay in diabetic and non-diabetic were same (3.5days) but total hospital stay was significantly higher in the former group (one day or more). Re-opening for bleeding, atrial fibrilation and cardiac arrest in ICU were found higher in DM than those in non-DM group (28.7%vs.20.7%,10.4% vs. 8% and 4.2% vs.1.1% respectively). Conclusion: Although the mortality rate of diabetic patients following CABG surgery was in significantly higher than their non-diabetic counterparts. Morbidity was also a bit higher. Strict perioperative glyacemic control could reduce morbidity and mortality in diabetic patients undergoing CABG.

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“…Specifically, the routine use of the left internal thoracic artery, 22 improvements in anesthesia and critical care, the use of off-pump CABG techniques, perioperative insulin infusion, [10][11][12][13][14][15] and improved secondary prevention protocols, 23 including antiplatelet medication, lipid-lowering regimens, and preoperative glucose modulation with insulin and oral hypoglycemic regimens, may have collectively improved outcomes in diabetic patients undergoing CABG. These differences may make interpretation of older studies [24][25][26][27][28] less reliable compared with current reports. In the present study, we sought to determine whether these outcome differences could be explained by preoperative glycemic control (as measured by HbA1c) rather than the mere history of diabetes mellitus.…”

Section: Discussionmentioning

confidence: 56%