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Diabetic control and coronary artery bypass: effect on short-term outcomes

2013; SAGE Publishing; Volume: 21; Issue: 3 Linguagem: Inglês

10.1177/0218492312451983

1816-5370

Stephen Strahan, Ryan Harvey, Andrew Campbell-Lloyd, Elaine Beller, Julie Mundy, Pallav Shah,

Bariatric Surgery and Outcomes

Aim: To evaluate the effect of preoperative glycemic control on hospital morbidity and mortality in diabetic patients undergoing primary coronary artery bypass grafting. Methods: Data of 3857 patients undergoing primary coronary artery bypass grafting was prospectively collected and retrospectively analyzed. There were 1109 (29%) diabetic patients, of whom 712 (64%) had hemoglobin A1c levels recorded. They were categorized by diabetic treatment: diet (179), oral hypoglycemic agent, (718) or insulin (212); and by diabetic control: hemoglobin A1c < 7 (265) or ≥7 (447). Nondiabetic patients (2,748) were used as controls. Results: The preoperative risk factors of hypertension ( p < 0.001), hyperlipidemia ( p < 0.001), renal failure ( p < 0.04), peripheral vascular disease ( p < 0.001), and chronic obstructive pulmonary disease ( p < 0.04) were significantly more prevalent in diabetic patients. Major complications were not significantly different between the diabetic and control groups ( p = 0.33), but minor complications were less frequent in diabetic patients ( p = 0.03). Major and minor complications were not significantly different among the treatment subgroups of diabetic patients ( p = 0.74 and p = 0.48) or in those with hemoglobin A1c < 7 and ≥7 ( p = 0.23, p = 0.41). Conclusions: Short-term outcomes were not affected by the degree of preoperative glycemic control or type of treatment used in diabetic patients undergoing primary coronary artery bypass grafting. A plausible explanation is strict protocol-driven glycemic control in the perioperative period.