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Abstract

Background: Optimal glycemic control in postoperative cardiac patients is still under debate. In an attempt to reduce wound infection, and improving overall mortality variable targets had been prescribed. Aim of the work: To study the outcome of glucose control, with a target of 6 to 8.1mmol/L, and the associated factors related to poor control. Methodology: We evaluated 227 consecutive patients diabetics and non-diabetics after cardiac surgery in a prospective descriptive study with purposive sampling. Patients subjected to insulin infusion with a target of 6 to 8.1mmol/L. We collected perioperative individual data including age, gender, race, Euro score, cardiopulmonary bypass time (CPB), aortic cross clamp time (ACC), length of ventilation, stay in intensive care unit (ICU) and in hospital as well as nurses compliance to follow the protocol. Patients divided into 2 groups according to the success of maintaining the target into group I (target maintained over 80% of the time), and group II (target maintained in less than 80 % of the time). The groups were compared by t-test, or Mann-Whitney U test, as appropriate for interval variables, and Chi square tests were for categorical variables. Data expressed as mean±SD or proportions/percentages for interval and categorical variables respectively. P<= 0.05 (two-tailed) was considered the statistical significant level. Results: Both groups were matched regarding the age, sex, gender, and Euro score. Failure to lie within the target was significantly higher in diabetics (p=0.001), patients with glycated hemoglobin (HbA1c) above 8% (p=0.0001), dopamine and adrenaline users (p=0.04&0.05 respectively). No significant difference found between the ethnic groups (Arab and Asians). CPB, and ACC time, lengths of stay ICU and ventilation were significantly higher in group II. Incidence of hypoglycemia, acute kidney injury, and in-hospital mortality did not differ between both groups, although wound infections were higher in group II. Conclusion: Pertinent aspects regarding better control within the studied population did not involve ethnicity as hypothesized, however preoperative high HbA1C appears to be a good predictor of poor control. Patients with proper glucose control had a better outcome in terms of wound infection, lengths of ventilation and ICU stay; moreover they were not subject to frequent hypoglycemic events as claimed.

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/content/papers/10.5339/qfarc.2014.HBPP0120
2014-11-18
2020-01-27
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