TY - JOUR
T1 - Diabetes and the association of postoperative hyperglycemia with clinical and economic outcomes in cardiac surgery
AU - Greco, Giampaolo
AU - Ferket, Bart S.
AU - D'Alessandro, David A.
AU - Shi, Wei
AU - Horvath, Keith A.
AU - Rosen, Alexander
AU - Welsh, Stacey
AU - Bagiella, Emilia
AU - Neill, Alexis E.
AU - Williams, Deborah L.
AU - Greenberg, Ann
AU - Browndyke, Jeffrey N.
AU - Gillinov, A. Marc
AU - Mayer, Mary Lou
AU - Keim-Malpass, Jessica
AU - Gupta, Lopa S.
AU - Hohmann, Samuel F.
AU - Gelijns, Annetine C.
AU - O'Gara, Patrick T.
AU - Moskowitz, Alan J.
N1 - Publisher Copyright:
© 2016 by the American Diabetes Association.
PY - 2016/3
Y1 - 2016/3
N2 - Objective The management of postoperative hyperglycemia is controversial and generally does not take into account pre-existing diabetes. We analyzed clinical and economic outcomes associated with postoperative hyperglycemia in cardiac surgery patients, stratifying by diabetes status. Research Design and Methods Multicenter cohort study in 4,316 cardiac surgery patients operated on in 2010. Glucose was measured at 6-h intervals for 48 h postoperatively. Outcomes included cost, hospital length of stay (LOS), cardiac and respiratory complications, major infections, and death. Associations between maximum glucose levels and outcomes were assessed with multivariable regression and recycled prediction analyses. Results In patients without diabetes, increasing glucose levels were associated with a gradual worsening of outcomes. In these patients, hyperglycemia (≥180 mg/dL) was associated with an additional cost of $3,192 (95% CI 1,972 to 4,456), an additional hospital LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to 2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3). However, among patients with insulin-treated diabetes, optimal outcomes were associated with glucose levels considered to be hyperglycemic (180 to 240 mg/dL). This level of hyperglycemia was associated with cost reductions of $6,225 (212,886 to 2222), hospital LOS reductions of 1.6 days (23.7 to 0.4), infection reductions of 4.1% (29.1 to 0.0), and reductions in respiratory complication of 12.5% (222.4 to 23.0). In patients with non-insulin-treated diabetes, outcomes did not differ significantly when hyperglycemia was present. Conclusions Glucose levels <180 mg/dL are associated with better outcomes in most patients, but worse outcomes in patients with diabetes with a history of prior insulin use. These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status.
AB - Objective The management of postoperative hyperglycemia is controversial and generally does not take into account pre-existing diabetes. We analyzed clinical and economic outcomes associated with postoperative hyperglycemia in cardiac surgery patients, stratifying by diabetes status. Research Design and Methods Multicenter cohort study in 4,316 cardiac surgery patients operated on in 2010. Glucose was measured at 6-h intervals for 48 h postoperatively. Outcomes included cost, hospital length of stay (LOS), cardiac and respiratory complications, major infections, and death. Associations between maximum glucose levels and outcomes were assessed with multivariable regression and recycled prediction analyses. Results In patients without diabetes, increasing glucose levels were associated with a gradual worsening of outcomes. In these patients, hyperglycemia (≥180 mg/dL) was associated with an additional cost of $3,192 (95% CI 1,972 to 4,456), an additional hospital LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to 2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3). However, among patients with insulin-treated diabetes, optimal outcomes were associated with glucose levels considered to be hyperglycemic (180 to 240 mg/dL). This level of hyperglycemia was associated with cost reductions of $6,225 (212,886 to 2222), hospital LOS reductions of 1.6 days (23.7 to 0.4), infection reductions of 4.1% (29.1 to 0.0), and reductions in respiratory complication of 12.5% (222.4 to 23.0). In patients with non-insulin-treated diabetes, outcomes did not differ significantly when hyperglycemia was present. Conclusions Glucose levels <180 mg/dL are associated with better outcomes in most patients, but worse outcomes in patients with diabetes with a history of prior insulin use. These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status.
UR - http://www.scopus.com/inward/record.url?scp=84962054162&partnerID=8YFLogxK
U2 - 10.2337/dc15-1817
DO - 10.2337/dc15-1817
M3 - Article
C2 - 26786574
AN - SCOPUS:84962054162
SN - 0149-5992
VL - 39
SP - 408
EP - 417
JO - Diabetes Care
JF - Diabetes Care
IS - 3
ER -