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Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients.

Abstract：

OBJECTIVE:To estimate the magnitude of association between intraoperative hyperglycemia and perioperative outcomes in patients who underwent cardiac surgery. PATIENTS AND METHODS:We conducted a retrospective observational study of consecutive adult patients who underwent cardiac surgery between June 10, 2002, and August 30, 2002, at the Mayo Clinic, a tertiary care center in Rochester, Minn. The primary independent variable was the mean intraoperative glucose concentration. The primary end point was a composite of death and infectious (sternal wound, urinary tract, sepsis), neurologic (stroke, coma, delirium), renal (acute renal failure), cardiac (new-onset atrial fibrillation, heart block, cardiac arrest), and pulmonary (prolonged pulmonary ventilation, pneumonia) complications developing within 30 days after cardiac surgery. RESULTS:Among 409 patients who underwent cardiac surgery, those experiencing a primary end point were more likely to be male and older, have diabetes mellitus, undergo coronary artery bypass grafting, and receive insulin during surgery (P< or =.05 for all comparisons). Atrial fibrillation (n=105), prolonged pulmonary ventilation (n=53), delirium (n=22), and urinary tract infection (n=16) were the most common complications. The initial, mean, and maximal intraoperative glucose concentrations were significantly higher in patients experiencing the primary end point (P<.01 for all comparisons). In multivariable analyses, mean and maximal glucose levels remained significantly associated with outcomes after adjusting for potentially confounding variables, including postoperative glucose concentration. Logistic regression analyses indicated that a 20-mg/dL increase in the mean intraoperative glucose level was associated with an increase of more than 30% in outcomes (adjusted odds ratio, 1.34; 95% confidence Interval, 1.10-1.62). CONCLUSION:Intraoperative hyperglycemia is an independent risk factor for complications, including death, after cardiac surgery.

journal_name

Mayo Clin Proc

journal_title

Mayo Clinic proceedings

authors

Gandhi GY,Nuttall GA,Abel MD,Mullany CJ,Schaff HV,Williams BA,Schrader LM,Rizza RA,McMahon MM

doi

10.4065/80.7.862

keywords:

subject

Has Abstract

pub_date

2005-07-01 00:00:00

pages

862-6

issue

eissn

0025-6196

issn

1942-5546

pii

S0025-6196(11)61560-7

journal_volume

pub_type

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Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients.