ABSTRACT
Background:
Diabetes is not uncommon in
patients requiring
cardiac surgery. These
patients have a higher
incidence of
morbidity and
mortality. Subsequently, diabetes represents a major medico-economic problem in both developed and
developing countries. This study was designed to observe the
association between
glycemic control and outcome of
patients after open
heart surgery in
adult population. Materials and
Methods:
Data was collected retrospectively in all
patients who underwent open
cardiac surgery (
coronary artery bypass grafting, valve, or bypass grafting with valve
surgery) and survived 72 hours postoperatively and had diabetes. The study was conducted from January 2015 to December 2016.
Results:
Of the 129
patients included in the study,
male dominated 101 (78.3%). Most frequent
surgery was
coronary artery bypass grafting (CABG) 123 (95.3%), CABG plus
aortic valve replacement 4 (3.1%), and CABG plus
mitral valve replacement 2 (1.6%). Considering diabetes, only 3 (2.3%) were on
diet control, 112 (86.8%) on oral
hypoglycemic agents (OHA), whereas 9 (7%) had control on both
insulin and OHA. Only 5 (3.9%) had type I diabetes. The mean
fasting blood sugar (FBS) was 154.58 g/dl, and the mean duration of diabetic mellitus was observed 12.32 years. Microvascular and macrovascular
complications were 26/129 (20.16%) and 17/129 (13.17%), respectively. Total 75 (58.1%)
patients did not require
insulin and 54 (41.9%) were treated with
insulin intraoperatively to keep the
blood glucose level less than 200 g/dl.
Cardiac arrhythmias were frequent in the
insulin group (P < 0.05), which was also associated with increased stay in the cardiac
intensive care unit.
Conclusion:
Inadequate
glycemic control during open
cardiac surgery can possibly
lead to increased perioperative
morbidity and
mortality and with decreased long-term
survival and recurrent ischemic events. Therefore, aiming for
blood glucose levels around 140 mg/dl appears reasonable. Further studies are required to define specific
glucose ranges for a clearer definition of recommended
blood glucose goals in postoperative cardiac
patients for the best outcomes in
patients with
diabetes mellitus.