Glycemic control in patients undergoing coronary artery bypass graft surgery: Clinical features, predictors, and outcomes.
PURPOSE: Critically ill patients with hyperglycemia have worse prognosis. The degree to which glycemic control is achieved following CABG surgery and the association with clinical outcomes is not well understood. MATERIALS AND METHODS: We studied patients undergoing higher risk CABG surgery at 55 US hospitals. Good glycemic control was defined as 70-180mg/dL in the first 24h postoperatively. Generalized estimating equations logistic regression models were used to assess the relationship between glycemic control and clinical outcomes after adjusting for baseline characteristics. RESULTS: Among 2032 patients only 297 (15%) had good glycemic control in the perioperative period, with 2% having at least one BS below 70, 63% having at least one BS above 180, and 9% having both. Patients with good glycemic control had lower rates of the risk-adjusted composite outcome of mortality and major complications (OR=0.66; 95% CI 0.46-0.93, p=0.02). Hypoglycemic events occurred in 250 (12%) patients, ranging among hospitals from 2% to 58%, p<0.001 and was not associated with hospitals' overall rate of good glucose control. CONCLUSIONS: Achieving glycemic control following high risk CABG was associated with lower operative mortality and morbidity, yet achieved in only 15% of patients. Hospitals varied considerably in their ability to achieve good glycemic control.
Williams, JB; Peterson, ED; Albrecht, ÁS; Li, S; Hirji, SA; Ferguson, T; Smith, PK; Lopes, RD
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