Complications of coronary artery surgery in diabetic patients
Fietsam, R.; Bassett, J.; Glover, J.L.
American Surgeon 57(9): 551-557
1991
ISSN/ISBN: 0003-1348 PMID: 1928997 Document Number: 386468
Postoperative mortality and morbidity of diabetic versus nondiabetic patients undergoing primary coronary artery bypass grafting (CABG) were analyzed. In 1988, 711 patients had CABG procedures, of which 565 were nondiabetic and 146 diabetic. The two groups of patients were statistically similar in regard to age, weight, tobacco and ethanol use, and preoperative levels of cholesterol, triglycerides, blood urea nitrogen (BUN), and creatinine. Preoperative serum glucose levels were significantly elevated in diabetic patients (182 vs. 106, P < .001). Cardiac output, ejection fraction, and bypass, crossclamp time, and total operating room times were not different for the two groups. Emergent and urgent procedures had a significantly higher mortality rate than elective cases (11.3% and 6.6% vs. 1.7%, rspectively; P < 0.05), but this was independent of the patient's diabetic status. Women had a higher mortality rate than men (6.5% vs. 2.9%; P = 0.05) although within each gender group, there were no differences between diabetics and nondiabetics. There were 27 patients with complications in the diabetic group (18.5%) and 47 in the nondiabetic group (8.3%; P < .001). The types of complications within the two groups differed in that wound infections (7.5%), postoperative arrhythmias (4.8%), respiratory failure (4.1%), and intra-aortic balloon pump use (4.1%) were significantly greater (P < .05) in the diabetic patients compared to the nondiabetic (0.9%, 1.8%, 0.4%, and 1.4%, respectively). Occurrences of postoperative pneumothorax, reoperation, myocardial infarction, stroke, urinary tract infection, and pneumonia were similar in both groups. Comparison of an obesity index (weight squared) and postoperative serum glucose between diabetic patients who developed wound infections, those with other complications, and diabetics with no complication is shown below. The obesity index is similar for all groups. While the trend is toward a greater elevation of postoperative serum glucose in those patients who developed wound infections, these differences were not statistically significant. The authors conclude that diabetic patients have an increased risk of wound infection, arrhythmia, and respiratory failure following CABG. However, the data do not support the idea that elevated postoperative serum glucose contributes to an increased wound infection rate.