Reduction of surgical mortality and morbidity in diabetic patients undergoing cardiac surgery with a combined intravenous and subcutaneous insulin glucose management strategy.

Full Abstract

OBJECTIVE:
To determine if glucose management in postcardiothoracic surgery patients with a combined intravenous (IV) and subcutaneous (SC) insulin regimen reduces mortality and morbidity in patients with diabetes and stress-induced hyperglycemia.

RESEARCH DESIGN AND METHODS:
Retrospective review of 614 consecutive patients who underwent cardiothoracic (CT) surgery in 2005 was performed to evaluate the incidence and treatment of postoperative hyperglycemia and operative morbidity and mortality. Hyperglycemic patients (glucose >6.05 mmol/l) were treated with IV insulin in the intensive care unit (ICU) followed by SC insulin (outside ICU). Subgroup analysis was performed on 159 coronary artery bypass grafting (CABG)-only patients.

RESULTS:
Among all CT surgeries, patients with a preoperative diagnosis of diabetes had higher rates of postoperative mortality (7.3 vs. 3.3%; P = 0.03) and pulmonary complications (19.5 vs. 11.6%; P = 0.02) but had similar rates of infections and cardiac, renal, and neurological complications on univariate analysis. However, on multivariate analysis, a preoperative diagnosis of diabetes was not a significant factor in postoperative mortality or pulmonary complications. In CABG-only patients, no significant differences were seen in outcomes between diabetic and nondiabetic patients. Independent of diabetic status, glucose > or =11 mmol/l on ICU admission was predictive of higher rates of mortality and renal, pulmonary, and cardiac postoperative complications.

CONCLUSIONS:
A combination of IV insulin (in the ICU) and SC insulin (outside the ICU), a less costly and less nursing-intensive therapy than 3 days of IV insulin postoperatively, results in a reduction of the increased surgical morbidity and mortality in diabetic patients after CT surgery.

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Author information

Author/s: Schmeltz, Lowell R (LR); DeSantis, Anthony J (AJ); Thiyagarajan, Vinaya (V); Schmidt, Kathleen (K); O'Shea-Mahler, Eileen (E); Johnson, Diana (D); Henske, Joseph (J); McCarthy, Patrick M (PM); Gleason, Thomas G (TG); McGee, Edwin C (EC); Molitch, Mark E (ME);

Affiliation: Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Journal and publication information

Publication Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't

Journal: Diabetes care (Diabetes Care), published in United States. (Language: eng)

Reference: 2007-Apr; vol 30 (issue 4) : pp 823-8

Dates: Created 2007/03/29; Completed 2007/06/13; Revised 2007/11/07;

PMID: 17229943, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Nat Clin Pract Endocrinol Metab. 2007 Oct;3(10):680-1. (PMID: 17667898)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Blood Glucose - metabolism
Cardiac Surgical Procedures - adverse effects; statistics & numerical data
Coronary Artery Bypass
Diabetic Angiopathies - drug therapy; surgery
Female
Heart Diseases - surgery
Humans
Injections, Intravenous

Injections, Subcutaneous
Insulin - administration & dosage; therapeutic use
Intraoperative Complications - prevention & control
Male
Middle Aged
Monitoring, Intraoperative
Postoperative Complications - epidemiology; prevention & control
Surgical Wound Infection - epidemiology
Treatment Outcome

Associated Chemicals: Blood Glucose (0) ; Insulin (11061-68-0)

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